bluuebunny/crossref_metadata_2025_split huggingface dataset:
Engagement and online mathematics enrichment for secondary students
Authors: Lyakhova Sofya , Neate Andrew 
Published: May 2024

Abstract
Online may not be the ideal format for a mathematics enrichment event, but in some circumstances, it may be the only option available. This article considers a mathematics enrichment programme consisting of a series of masterclasses which were held live online for secondary students in the UK during the Covid-19 pandemic. The series of masterclasses were part of the Royal Institution of Great Britain’s Mathematics Masterclass Programme which runs annually across the UK. In this study, we investigate how and to what extent students were able to engage with this series of online masterclasses. Learner engagement is researched through in-session observations, student work, attendance data, participant feedback and interviews. While the online masterclass series lost some of its traditional in person features, such as hands-on live social interaction and a university environment, it appeared that the participants perceived the online sessions as interactive enabling them to both enjoy the sessions and enjoy learning mathematics in the sessions. The evidence found suggests that the participating students could engage behaviourally, emotionally and cognitively in online mathematics enrichment. However, constructing mathematical knowledge in online sessions can be difficult for some students and social interaction may need to rely on existing social groups among school friends.
Long-term evolution of human seasonal influenza virus A(H3N2) is associated with an increase in polymerase complex activity
Authors: Vigeveno René M , Han Alvin X , de Vries Robert P , Parker Edyth , de Haan Karen , van Leeuwen Sarah , Hulme Katina D , Lauring Adam S , te Velthuis Aartjan J W , Boons Geert-Jan , Fouchier Ron A M , Russell Colin A , de Jong Menno D , Eggink Dirk 
Published: May 2024

Abstract
Since the influenza pandemic in 1968, influenza A(H3N2) viruses have become endemic. In this state, H3N2 viruses continuously evolve to overcome immune pressure as a result of prior infection or vaccination, as is evident from the accumulation of mutations in the surface glycoproteins hemagglutinin (HA) and neuraminidase (NA). However, phylogenetic studies have also demonstrated ongoing evolution in the influenza A(H3N2) virus RNA polymerase complex genes. The RNA polymerase complex of seasonal influenza A(H3N2) viruses produces mRNA for viral protein synthesis and replicates the negative sense viral RNA genome (vRNA) through a positive sense complementary RNA intermediate (cRNA). Presently, the consequences and selection pressures driving the evolution of the polymerase complex remain largely unknown. Here, we characterize the RNA polymerase complex of seasonal influenza A(H3N2) viruses representative of nearly 50 years of influenza A(H3N2) virus evolution. The H3N2 polymerase complex is a reassortment of human and avian influenza virus genes. We show that since 1968, influenza A(H3N2) viruses have increased the transcriptional activity of the polymerase complex while retaining a close balance between mRNA, vRNA, and cRNA levels. Interestingly, the increased polymerase complex activity did not result in increased replicative ability on differentiated human airway epithelial (HAE) cells. We hypothesize that the evolutionary increase in polymerase complex activity of influenza A(H3N2) viruses may compensate for the reduced HA receptor binding and avidity that is the result of the antigenic evolution of influenza A(H3N2) viruses.
Changing Nurse Education Meaningfully
Authors: Wilson Deborah H. , Hemmer Brigit , Werk Alicia , Han Hae-Ra 
Published: May 2024

Abstract
Nurse educators are called to increase diversity in the clinical and faculty workforce; promote safe, inclusive learning environments; develop curricula that provide an anti-biased view of patients and health conditions; and provide students with educational opportunities to learn from individuals with diverse backgrounds. An innovative curriculum design inclusive of Indigenous worldviews was implemented at a tribal college. It provides an exemplar that supports diverse student learning, retention, and graduation. A curriculum inclusive of experiences that promote reflective practices and cultural safety can contribute toward a diverse, inclusive nursing workforce that provides equitable care while addressing social determinants of health.
Patient and Hospital Characteristics Associated with Admission Among Patients With Minor Isolated Extremity Firearm Injuries: A Propensity-Matched Analysis
Authors: Thomas Arielle C. , Royan Regina , Nathens Avery B. , Campbell Brendan T. , Reddy Susheel , Spitzer Sarabeth , Hamad Doulia , Jang Angie , Stey Anne M. 
Published: May 2024

Objective:
To quantify the association between insurance and hospital admission following minor isolated extremity firearm injury.

Background:
The association between insurance and injury admission has not been examined.

Methods:
This was an observational retrospective cohort study of minor isolated extremity firearm injury captured in the Healthcare Cost and Utilization Project State Inpatient and Emergency Department Databases in 6 states (New York, Arkansas, Wisconsin, Massachusetts, Florida, and Maryland) from 2016 to 2017 among patients aged 16 years or older. The primary exposure was insurance. Admitted patients were propensity score matched to nonadmitted patients on age, extremity Abbreviated Injury Score, and Elixhauser Comorbidity Index with exact matching within hospital to adjust for selection bias. A general estimating equation logistic regression estimated the association between insurance and odds of admission in the matched cohort while controlling for sex, race, injury intent, injury type, hospital profit type, and trauma center designation with observations clustered by propensity score-matched pairs within hospital.

Results:
A total of 8151 patients presented to hospital with a minor isolated extremity firearm injury between 2016 and 2017 in 6 states. Patients were 88.0% male, 56.6% Black, and 71.7% aged 16 to 36 years old, and 22.1% were admitted. A total of 2090 patients were matched on propensity for admission. Privately insured matched patients had 1.70 higher adjusted odds of admission and 95% confidence interval of 1.30 to 2.22, compared with uninsured after adjusting for patient and hospital characteristics.

Conclusions:
Insurance was associated with hospital admission for minor isolated extremity firearm injury.
Temporal Trends of Improvement After Minimally Invasive Transforaminal Lumbar Interbody Fusion
Authors: Shahi Pratyush , Subramanian Tejas , Tuma Olivia , Singh Sumedha , Araghi Kasra , Asada Tomoyuki , Korsun Maximilian , Singh Nishtha , Simon Chad , Vaishnav Avani , Mai Eric , Zhang Joshua , Kwas Cole , Allen Myles , Kim Eric , Heuer Annika , Sheha Evan , Dowdell James , Qureshi Sheeraz , Iyer Sravisht 
Published: May 2024

Study Design.
Retrospective review of prospectively collected data.

Objective.
To analyze temporal trends in improvement after minimally invasive transforaminal lumbar interbody fusion (MIS TLIF).

Summary of Background Data.
Although several studies have shown that patients improve significantly after MIS TLIF, evidence regarding the temporal trends in improvement is still largely lacking.

Methods.
Patients who underwent primary single-level MIS TLIF for degenerative conditions of the lumbar spine and had a minimum of 2-year follow-up were included. Outcome measures were: 1) patient reported outcome measures (PROMs) (Oswestry Disability Index, ODI; Visual Analog Scale, VAS back and leg; 12-Item Short Form Survey Physical Component Score, SF-12 PCS); 2) global rating change (GRC); 3) minimal clinically important difference (MCID); and 4) return to activities. Timepoints analyzed were preoperative, 2 weeks, 6 weeks, 3 months, 6 months, 1 year, and 2 years. Trends across these timepoints were plotted on graphs.

Results.
236 patients were included. VAS back and VAS leg were found to have statistically significant improvement compared to the previous timepoint up to 3 months after surgery. ODI and SF-12 PCS were found to have statistically significant improvement compared to the previous timepoint up to 6 months after surgery. Beyond these timepoints, there was no significant improvement in PROMs. 80% of patients reported feeling better compared to preoperative by 3 months. >50% of patients achieved MCID in all PROMs by 3 months. Most patients returned to driving, returned to work, and discontinued narcotics at an average of 21, 20, and 10 days, respectively.

Conclusions.
Patients are expected to improve up to 6 months after MIS TLIF. Back pain and leg pain improve up to 3 months and disability and physical function improve up to 6 months. Beyond these timepoints, the trends in improvement tend to reach a plateau. 80% of patients feel better compared to preoperative by 3 months after surgery.
MRI Vertebral Bone Quality Correlates With Interbody Cage Subsidence After Anterior Cervical Discectomy and Fusion
Authors: Bernatz James T. , Pumford Andrew , Goh Brian C. , Pinter Zachariah W. , Mikula Anthony L. , Michalopoulos Giorgos D. , Bydon Mohamad , Huddleston Paul , Nassr Ahmad N. , Freedman Brett A. , Sebastian Arjun S. 
Published: May 2024

Study Design:
Retrospective observational study of consecutive patients

Objective:
The purpose of the study was to evaluate VBQ as a predictor of interbody subsidence and to determine threshold values that portend increased risk of subsidence.

Summary of Background Data:
Many risk factors have been reported for the subsidence of interbody cages in anterior cervical discectomy and fusion (ACDF). MRI Vertebral Bone Quality (VQB) is a relatively new radiographic parameter that can be easily obtained from preoperative MRI and has been shown to correlate with measurements of bone density such as DXA and CT Hounsfield Units.

Methods:
All patients who underwent 1- to 3-level ACDF using titanium interbodies with anterior plating between the years 2018 and 2020 at our tertiary referral center were included. Subsidence measurements were performed by 2 independent reviewers on CT scans obtained 6 months postoperatively. VBQ was measured on pre-operative sagittal T1 MRI by 2 independent reviewers, and values were averaged.

Results:
Eight-five fusion levels in 44 patients were included in the study. There were 32 levels (38%) with moderate subsidence and 12 levels with severe subsidence (14%). The average VBQ score in those patients with severe subsidence was significantly higher than those without subsidence (3.80 vs. 2.40, P<0.01). A threshold value of 3.2 was determined to be optimal for predicting subsidence (AUC=0.99) and had a sensitivity of 100% and a specificity of 94.1% in predicting subsidence.

Conclusions:
VBQ strongly correlates with the subsidence of interbody grafts after ACDF. A threshold VBQ score value of 3.2 has excellent sensitivity and specificity for predicting subsidence. Spine surgeons can use VBQ as a readily available screening tool to identify patients at higher risk for subsidence.

Level of Evidence:
Level—IV
Preexisting Diabetes Mellitus and All-Cause Mortality in Adult Patients With Sepsis: A Population-Based Cohort Study
Authors: Angriman Federico , Saoraya Jutamas , Lawler Patrick R. , Shah Baiju R. , Martin Claudio M. , Scales Damon C. ,   on behalf of the Sepsis Canada Network
Published: May 2024

OBJECTIVES:
We assessed the association of preexisting diabetes mellitus with all-cause mortality and organ support receipt in adult patients with sepsis.

DESIGN:
Population-based cohort study.

SETTING:
Ontario, Canada (2008–2019).

POPULATION:
Adult patients (18 yr old or older) with a first sepsis-related hospitalization episode.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
The main exposure of interest was preexisting diabetes (either type 1 or 2). The primary outcome was all-cause mortality by 90 days; secondary outcomes included receipt of invasive mechanical ventilation and new renal replacement therapy. We report adjusted (for baseline characteristics using standardization) risk ratios (RRs) alongside 95% CIs. A main secondary analysis evaluated the potential mediation by prior metformin use of the association between preexisting diabetes and all-cause mortality following sepsis. Overall, 503,455 adults with a first sepsis-related hospitalization episode were included; 36% had preexisting diabetes. Mean age was 73 years, and 54% of the cohort were females. Preexisting diabetes was associated with a lower adjusted risk of all-cause mortality at 90 days (RR, 0.81; 95% CI, 0.80–0.82). Preexisting diabetes was associated with an increased risk of new renal replacement therapy (RR, 1.53; 95% CI, 1.46–1.60) but not invasive mechanical ventilation (RR, 1.03; 95% CI, 1.00–1.05). Overall, 21% (95% CI, 19–28) of the association between preexisting diabetes and reduced risk of all-cause mortality was mediated by prior metformin use.

CONCLUSIONS:
Preexisting diabetes is associated with a lower risk of all-cause mortality and higher risk of new renal replacement therapy among adult patients with sepsis. Future studies should evaluate the underlying mechanisms of these associations.
Independent and Added Value of Cardiopulmonary Exercise Testing to New York Heart Association Classification in Patients With Heart Failure
Authors: de Souza Isabela Pilar Moraes Alves , Ramos João Victor Santos Pereira , da Silveira Anderson Donelli , Stein Ricardo , Ribeiro Rebeca Sadigursky , Pazelli Alexandre Meira , de Oliveira Queila Borges , Darzé Eduardo Sahade , Ritt Luiz Eduardo Fonteles 
Published: May 2024

Purpose:
The objective of this study was to evaluate the independent and added value of a cardiopulmonary exercise test (CPX) to New York Heart Association (NYHA) functional analysis in patients with heart failure (HF) and ejection fraction (EF) <50%.

Methods:
Patients (n = 613) with HF and EF < 50% underwent CPX and were followed for 28 ± 17 mo with respect to primary outcomes (death or heart transplantation).

Results:
Mean patient age was 56 ± 12 yr, and 64% were male. Most patients were classified as NYHA class II (41%). The composite rate of primary outcomes was 12%; death occurred in 9%, and heart transplant in 4%. Independent predictors of primary outcomes were: EF (HR = 0.95: 95% CI, 0.92-0.98; P = .001) and NYHA (HR = 2.06: 95% CI, 1.54-2.75; P < .0001). When added to the model, peak oxygen uptake (V˙O
2peak) was an independent predictor (HR = 0.90: 95% CI, 0.84-0.96; P = .001), as was the percentage of predicted V˙O
2peak (HR = 0.03: 95% CI, 0.007-0.147; P < .001), minute ventilation/carbon dioxide production slope (HR = 1.02: 95% CI, 1.01-1.04; P = .012), and CPX score (HR = 1.16: 95% CI, 1.06-1.27; P = .001).

Conclusions:
CPX variables were independent predictors of HF prognosis, even when controlled by NYHA functional class. Despite being independent predictors, the value added to NYHA classification was modest and lacked statistical significance.
Characteristics and Treatment Outcomes of Hypotony Maculopathy Postglaucoma Filtering Surgery: An Optical Coherence Tomography-Based Study
Authors: Strzalkowska Alicja , Braegelmann Lisa , Strzalkowski Piotr , Stingl Julia V. , Hoffmann Esther M. , Pfeiffer Norbert , Schuster Alexander K. 
Published: May 2024

Précis:
Bleb revision procedures for hypotony maculopathy (HM) following glaucoma filtering surgery show promising outcomes, including notable improvements in visual acuity and IOP.

Purpose:
This study assesses morphologic characteristics using SD-OCT in patients with HM following glaucoma filtering surgery and evaluates the results of its treatment.

Materials and Methods:
A retrospective analysis of all HM patients between January 2019 and March 2023. Inclusion criteria consisted of both preoperative and postrevision SD-OCT images of the macula and the presence of HM as observed on OCT images preoperatively. HM was graded according to its appearance in OCT both prerevision and postrevision surgery. Changes in visual acuity and IOP were assessed.

Results:
A total of 45 eyes of 45 patients were included. In all, 21 eyes had HM limited to retinal pigment epithelium (RPE), 18 eyes had involvement of RPE and photoreceptor layers, and 6 eyes had additional intraretinal or subretinal edema. After revision surgery with IOP elevation, 64% of eyes had complete HM regression with no HM signs in OCT imaging. Overall, 80% of patients achieved at least 1 grade improvement in HM. Preoperative visual acuity increased from 0.7±0.4 (logMAR) to 0.4±0.4 at 2 weeks postoperatively, over the course of an increase of IOP from 3.5±1.8 to 17.1±10.6 mm Hg at day 1. Eyes with complete HM regression had higher IOP at day 1 compared with those without improvement (P=0.04). The median time between HM onset and revision was 10.0 days for those with complete regression and 27 days for those without improvement (P=0.04).

Conclusions:
Bleb revision procedures for HM following glaucoma filtering surgery show promising outcomes, including notable improvements in visual acuity and IOP. The timing of revision surgery appears to influence the outcome. In our study, earlier intervention was associated with better results. Even delayed surgeries can lead to an improvement, although complete morphologic restoration may not be achieved in advanced grades of HM.
One-Year Outcomes of Preserflo Microshunt for Primary Open Angle Glaucoma: A Systematic Review and Meta-Analysis
Authors: Pietris James , Casson Robert 
Published: May 2024

Précis:
This systematic review and meta-analysis concludes that the PreserFlo Microshunt glaucoma drainage device significantly reduces intraocular pressure in primary open angle glaucoma patients at 12 months postinsertion.

Purpose:
A systematic review and meta-analysis on the effect of the PRESERFLO MicroShunt (PF-MS) on intraocular pressure (IOP) at 12 months has been conducted.

Method:
The PubMed/MEDLINE, Embase, CENTRAL, Google Scholar, Scopus, and Web of Science databases were searched. Inclusion criteria required a diagnosis of open angle glaucoma, PF-MS insertion, and examination of IOP over time. Meta-analyses were conducted on the primary outcome of IOP and the secondary outcome of glaucoma medication regime. Adverse events were also noted.

Results:
Fourteen studies were identified for inclusion in the meta-analyses, of which none had a high risk of bias. The meta-analyses found a significant mean reduction in IOP of 9.07 mm Hg (95% CI: 7.88–10.25; P<0.0001) and a significant mean reduction in mean glaucoma medication requirement of 2.37 medications (95% CI: 2.15–2.60; P<0.0001). Hypotony and hyphaema are common early complications.

Conclusions:
The PF-MS device significantly reduced both IOP and glaucoma medication requirement at 12 months postinsertion in individuals with open angle glaucoma without a significant adverse event burden. Further research is required to determine the economic and environmental effects of widely implementing the PF-MS device into clinical practice.
The downside to choice: instrumental control increases conditioned nocebo hyperalgesia
Authors: Tang Biya , Livesey Evan , Colagiuri Ben 
Published: May 2024

Abstract
Nocebo hyperalgesia is a pervasive problem in which the treatment context triggers negative expectations that exacerbate pain. Thus, developing ethical strategies to mitigate nocebo hyperalgesia is crucial. Emerging research suggests that choice has the capacity to reduce nocebo side effects, but choice effects on nocebo hyperalgesia have not been explored. This study investigated the impact of choice on conditioned nocebo hyperalgesia using a well-established electrocutaneous pain paradigm where increases in noxious stimulation were surreptitiously paired with the activation of a sham device. In study 1, healthy volunteers (N = 104) were randomised to choice over (nocebo) treatment administration, nocebo administration without choice, or a natural history control group. Nocebo hyperalgesia was greater for those with choice than no choice, suggesting that choice increased rather than diminished nocebo hyperalgesia. Study 2 tested whether providing positive information about the benefits of choice in coping with pain could counteract heightened nocebo hyperalgesia caused by choice. A different sample of healthy adults (N = 137) were randomised to receive nocebo treatment with choice and positive choice information, choice only, or no choice. The positive choice information failed to attenuate the effect of choice on nocebo hyperalgesia. The current results suggest that, rather than decreasing nocebo hyperalgesia, treatment choice may exacerbate pain outcomes when a painful procedure is repeatedly administered. As such, using choice as a strategy to mitigate nocebo outcomes should be treated with caution.
Outcome Measures in Adult Vulvar Lichen Sclerosus: A Case Series of Women Diagnosed as Juveniles
Authors: Morrel Beth , ten Kate-Booij Marianne J. , van Dijk Charlotte , van Hees Colette L.M. , Wigny Kiki M.G.J. , Burger Curt W. , Pasmans Suzanne G.M.A. , van der Avoort Irene A.M. 
Published: May 2024

Objectives
Studies on the consequences of juvenile vulvar lichen sclerosus (JVLS) in adulthood are limited. A number of measuring tools are available for analyzing adult vulvar lichen sclerosus (VLS), but these have not been applied in studies on JVLS. The aim is to study physical findings, quality of life, sexual well-being, and self-image in adult women with a history of juvenile VLS.

Materials and Methods
Adult women with a biopsy proven history of JVLS were recruited to be examined and surveyed using available standardized measurement tools. This took place in an outpatient setting by physicians who were not involved in the treatment of participants.

Results
Twenty-seven women (median age 29 years) with a history of JVLS and median time since biopsy of 19.5 years were recruited. Of these women, 59% currently had symptoms, 63% had signs of active disease, and 85% had moderate to severe architectural changes. Despite these residual signs, vulvar specific-quality of life and vulvar self-image scored favorably while generic health-related quality of life was somewhat effected.

Conclusions
JVLS has consequences in adulthood involving physical findings and vulvar quality of life. The use of standardized outcome measures for clinical practice and research purposes facilitates a better understanding of the sequelae to JVLS.