bluuebunny/crossref_metadata_2025_split huggingface dataset:
Training and experience of coding with the World Health Organization’s International Classification of Diseases, Eleventh Revision
Authors: Eastwood Cathy A , Southern Danielle A , Doktorchik Chelsea , Khair Shahreen , Cullen Denise , Boxill Alicia , Maciszewski Malgorzata , Varela Lucia Otero , Ghali William , Moskal Lori , Quan Hude 
Published: September 2021

Background: The new International Classification of Diseases, Eleventh Revision for Mortality and Morbidity Statistics (ICD-11) was developed and released by the World Health Organization (WHO) in June 2018. Because ICD-11 incorporates new codes and features, training materials for coding with ICD-11 are urgently needed prior to its implementation. Objective: This study outlines the development of ICD-11 training materials, training processes and experiences of clinical coders while learning to code using ICD-11. Method: Six certified clinical coders were recruited to code inpatient charts using ICD-11. Training materials were developed with input from experts from the Canadian Institute for Health Information and the WHO, and the clinical coders were trained to use the new classification. Monthly team meetings were conducted to enable discussions on coding issues and to select the correct ICD-11 codes. The training experience was evaluated using qualitative interviews, a questionnaire and a coding quiz. Results: total of 3011 charts were coded using ICD-11. In general, clinical coders provided positive feedback regarding the training program. The average score for the coding quiz (multiple choice, True/False) was 84%, suggesting that the training program was effective. Feedback from the coders enabled the ICD-11 code content, electronic tooling and terminologies to be updated. Conclusion: This study provides a detailed account of the processes involved with training clinical coders to use ICD-11. Important findings from the interviews were reported at the annual WHO conferences, and these findings helped improve the ICD-11 browser and reference guide.
Eight Weeks of Self-Resisted Neck Strength Training Improves Neck Strength in Age-Grade Rugby Union Players: A Pilot Randomized Controlled Trial
Authors: Attwood Matthew J. , Hudd Lewis-Jon W. , Roberts Simon P. , Irwin Gareth , Stokes Keith A. 
Published: September 2021

Background: Greater neck strength is associated with fewer head and neck injuries. Neck-strengthening programs are commonly burdensome, requiring specialist equipment or significant time commitment, which are barriers to implementation. Hypothesis: Completing a neck-strengthening program will increase isometric neck strength in age-group rugby players. Study Design: A pilot randomized controlled exercise intervention study. Level of Evidence: Level 2. Methods: Twenty-eight U18 (under 18) male regional age-group rugby union players were randomized (intervention n =15/control n = 13). An 8-week exercise program was supervised during preseason at the regional training center. Control players continued their “normal practice,” which did not include neck-specific strengthening exercises. The 3-times weekly trainer-led intervention program involved a series of 15-second self-resisted contractions, where players pushed maximally against their own head, in forward, backward, left, and right directions. Outcome Measure: Peak isometric neck strength (force N) into neck flexion, extension, and left and right side flexion was measured using a handheld dynamometer. Results: Postintervention between-group mean differences (MDs) in isometric neck strength change were adjusted for baseline strength and favored the intervention for total neck strength (effect size [ES] = 1.2, MD ± 95% CI = 155.9 ± 101.9 N, P = 0.004) and for neck strength into extension (ES = 1.0, MD ± 95% CI = 59.9 ± 45.4 N, P = 0.01), left side flexion (ES = 0.7, MD ± 95% CI = 27.5 ± 26.9 N, P = 0.05), and right side flexion (ES = 1.3, MD ± 95% CI = 50.5 ± 34.4 N, P = 0.006). Conclusion: This resource-efficient neck-strengthening program has few barriers to implementation and provides a clear benefit in U18 players’ neck strength. While the present study focused on adolescent rugby players, the program may be appropriate across all sports where head and neck injuries are of concern and resources are limited. Clinical Relevance: Greater neck strength is associated with fewer head and neck injuries, including concussion. Performing this neck exercise program independently, or as part of a whole-body program like Activate, an interactive guide for players and coaches, could contribute to lower sports-related head and neck injuries.
The Rise of Private Tutoring in Denmark: An Entrepreneur's Perspectives and Experiences
Authors: Kany Nicklas 
Published: September 2021

• This article sheds light on the emergence of private tutoring in Denmark. Written from the perspective of a tutoring entrepreneur, it discusses the challenges and opportunities faced by a fledgling tutoring company in present-day Danish society. • The article is a personal narrative of the author's experience with establishing the first major Danish tutoring company. • The enthusiastic response by parents to the services offered by the author's company shows that there has long existed a hitherto unmet need for private tutoring in Denmark. However, the author also argues that the political turmoil surrounding the 2013 Danish school reform made parents increasingly sceptical that mainstream schools could effectively address the needs of their children. It thereby prepared the ground for launching a private tutoring concept. • It is only in the last decade that private tutoring has emerged in Denmark. The article provides a unique insider's perspective on this largely unexplored development.
Contemporary Practice Patterns for the Treatment of Anterior Cruciate Ligament Tears in the United States
Authors: Cevallos Nicolas , Soriano Kylen K.J. , Lansdown Drew A. , Ma C. Benjamin , Feeley Brian T. , Zhang Alan L. 
Published: September 2021

Background: There is a lack of research investigating current practice trends in the treatment of anterior cruciate ligament (ACL) tears as well as common concomitant procedures and reoperations associated with ACL reconstruction (ACLR). Purpose: To analyze current practice patterns for ACLR as well as the frequency of concomitant and revision procedures with respect to patient characteristics in a cross-sectional population of the United States. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Patient data between 2010 and 2017 were queried using the Mariner PearlDiver database. International Classification of Diseases, Ninth Revision (in 2010-2014) and Tenth Revision (ICD-10; in 2015-2017), diagnosis codes were used to identify ACL tears, and Current Procedural Terminology codes were used to identify ACLR and concomitant surgical procedures. Patient characteristics were stratified by sex and age. Cases of subsequent knee surgery and conversion to total knee arthroplasty (TKA) within 2 years after ACLR were tracked using ICD-10 codes between 2015 and 2017 to ensure ipsilateral laterality. Results: Of 229,295 patients identified with an ACL tear diagnosis during the study period, 75% underwent ACLR. In patients aged 10 to 39 years, 84% to 92% underwent ACLR, while patients aged 50 to 59 (50%) and 60 to 69 (28%) years were less likely to have surgery after an ACL tear. Female and male patients underwent ACLR at a similar rate (75%). Within the patients who underwent ACLR, 44% underwent concomitant meniscal debridement as compared with 11% with concomitant meniscal repair. Male patients were more likely to undergo meniscal debridement (48% vs 40%; P < .0001). The frequency of meniscal repair increased from 9% in 2010 to 14% in 2017, while the frequency of meniscal debridement decreased from 47% to 41% ( P < .0001). Within 2 years of ACLR, 6% of patients underwent revision ACLR; 4%, subsequent meniscal debridement; 1%, meniscal repair; and 1%, conversion to TKA. Conclusion: The frequency of ACLR for ACL tears has remained relatively stable in recent years and was similar between female and male patients in this cross-sectional population. The majority of patients aged 10 to 39 years underwent ACLR, while less than half of patients >50 years underwent surgery.
Mycoplasma pneumoniaecarriage evades induction of protective mucosal antibodies
Authors: de Groot Ruben Cornelis Anthonie , Estevão Silvia Cristina , Meyer Sauteur Patrick Michael , Perkasa Aditya , Hoogenboezem Theo , Spuesens Emiel Benny Margriet , Verhagen Lilly Maria , van Rossum Anna Maria Christiane , Unger Wendy Wilhelmina Josephina 
Published: September 2021

BackgroundMycoplasma pneumoniaeis the most common bacterial cause of pneumonia in children hospitalised for community-acquired pneumonia (CAP). Prevention of infection by vaccines may be an important strategy in the presence of emerging macrolide-resistantM. pneumoniae.However, knowledge of immune responses toM. pneumoniaeis limited, complicating vaccine design.MethodsWe studied the antibody response duringM. pneumoniaerespiratory tract infection and asymptomatic carriage in two different cohorts.ResultsIn a nested case–control study (n=80) ofM. pneumoniaecarriers and matched controls we observed that carriage byM. pneumoniaedoes not lead to a rise in either mucosal or systemicM. pneumoniae-specific antibodies, even after months of persistent carriage. We replicated this finding in a second cohort (n=69) and also found that duringM. pneumoniaeCAP, mucosal levels ofM. pneumoniae-specific IgA and IgG did increase significantly.In vitroadhesion assays revealed that high levels ofM. pneumoniae-specific antibodies in nasal secretions of paediatric patients prevented the adhesion ofM. pneumoniaeto respiratory epithelial cells.ConclusionsOur study demonstrates thatM. pneumoniae-specific mucosal antibodies protect against bacterial adhesion to respiratory epithelial cells, and are induced only duringM. pneumoniaeinfection and not during asymptomatic carriage. This is strikingly different from carriage with bacteria such asStreptococcus pneumoniaewhere mucosal antibodies are induced by bacterial carriage.
Factors affecting adherence with treatment advice in a clinical trial of patients with severe asthma
Authors: Busby John , Matthews John G. , Chaudhuri Rekha , Pavord Ian D. , Hardman Timothy C. , Arron Joseph R. , Bradding Peter , Brightling Christopher E. , Choy David F. , Cowan Douglas C. , Djukanovic Ratko , Hanratty Catherine E. , Harrison Tim W. , Holweg Cecile T. , Howarth Peter H. , Fowler Stephen J. , Lordan James L. , Mansur Adel H. , Menzies-Gow Andrew , Niven Robert M. , Robinson Douglas S. , Walker Samantha M. , Woodcock Ashley , Heaney Liam G. 
Published: September 2021

BackgroundUnderstanding why patients with severe asthma do not follow healthcare provider (HCP) advice to adjust treatment is critical to achieving personalised disease management.MethodsWe reviewed patient choice to follow HCP advice to adjust asthma treatment in a UK-based randomised, controlled, single-blind (study participant), multicentre, parallel group 48-week clinical study comparing biomarker-directed treatment adjustment with standard care in severe asthma.ResultsOf 1572 treatment advisories (291 participants), instructions were followed in 1377 cases (87.6%). Patients were more likely to follow advice to remain on treatment (96.7%) than to either reduce (70.3%) or increase (67.1%) their treatment, with 64% of patients following all treatment advice. Multivariate analysis associated belonging to an ethnic minority group (OR 3.10, 95% CI 1.68–5.73) and prior study medication changes (two or more changes: OR 2.77, 95% CI 1.51–5.10) with failure to follow treatment advice. In contrast, emergency room attendance in the prior year (OR 0.54, 95% CI 0.32–0.92) was associated with following treatment advice. The largest effect was seen with transition onto or off oral corticosteroids (OR 29.28, 95% CI 16.07–53.36) when compared with those requested to maintain treatment. Centre was also an important determinant regarding the likelihood of patients to follow treatment advice.ConclusionsBelonging to an ethnic minority group and multiple prior treatment adjustments were associated with not following HCP treatment advice. Patients also responded differently to HCP advice across UK specialist centres. These findings have implications for the generalisability of models of care in severe asthma and require further focused studies.
Salivary detection of COVID-19: clinical performance of oral sponge sampling for SARS-CoV-2 testing
Authors: Boutros Jacques , Benzaquen Jonathan , Marquette Charles Hugo , Ilié Marius , Labaky Mickelina , Benchetrit Didier , Lavrut Thibaut , Leroy Sylvie , Chemla Richard , Carles Michel , Tanga Virginie , Maniel Charlotte , Bordone Olivier , Allégra Maryline , Lespinet Virginie , Fayada Julien , Griffonnet Jennifer , Hofman Véronique , Hofman Paul 
Published: September 2021

BackgroundThe current diagnostic standard for coronavirus disease 2019 (COVID-19) is reverse transcriptase-polymerase chain reaction (RT-PCR) testing with nasopharyngeal (NP) swabs. The invasiveness and need for trained personnel make the NP technique unsuited for repeated community-based mass screening. We developed a technique to collect saliva in a simple and easy way with the sponges that are usually used for tamponade of epistaxis. This study was carried out to validate the clinical performance of oral sponge (OS) sampling for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing.MethodsOver a period of 22 weeks, we collected prospectively 409 paired NP and OS samples from consecutive subjects presenting to a public community-based free screening centre. Subjects were referred by their attending physician because of recent COVID-19 symptoms (n = 147) or by the contact tracing staff of the French public health insurance because they were considered as close contacts of a laboratory-confirmed COVID-19 case (n = 262).ResultsIn symptomatic subjects, RT-PCR SARS-CoV-2 testing with OS showed a 96.5% (95% CI: 89.6–94.8) concordance with NP testing, and a 93.2% (95% CI: 89.1–97.3) sensitivity when using the IdyllaTM platform and a sensitivity of 76.3% (95% CI: 69.4–83.2) on the Synlab Barla laboratory platform. In close contacts the NP-OS concordance (93.8%, 95% CI: 90.9–96.7) and OS sensitivity (71.9%, 95% CI: 66.5–77.3) were slightly lower.ConclusionThese results strongly suggest that OS testing is a straightforward, low-cost and high-throughput sampling method that can be used for frequent RT-PCR testing of COVID-19 patients and mass screening of populations.
Fungal keratitis caused by Pseudallescheria boydii: clinical and mycological characteristics
Authors: Izadi Alireza , Soleimani Mohammad , dos Santos Claudy Oliveira , Tehupeiory-Kooreman Marlou C. , Daie Ghazvini Roshanak , Hashemi Seyed Jamal , Gramishoar Mohssen , Aminizadeh Mehdi , Abedinifar Zohre , Verweij Paul E. , Khodavaisy Sadegh 
Published: September 2021

Abstract
Background
Pseudallescheria keratitis is rare but important type of fungal keratitis because of the inherently resistance of the organism to many existing antifungal agents.

Methods
Slit-lamp and confocal microscopy were used for clinical examinations. Fungal isolates were identified based on morphological characteristics and DNA sequence of the internal transcribed spacer region (ITS). In vitro antifungal susceptibility testing for fungal isolates was performed according to the Clinical and Laboratory Standards Institute (CLSI, M38-A2).

Result
All patients had a history of ocular trauma. In clinical examination hypopion were seen in three patients. The main antifungal medications were topical voriconazole. After treatment the visual acuity of all patients improved in 2–3 weeks.

Conclusion
All four patients of Pseudallescheria keratitis had similar clinical features. Accurate and rapid identification of species should be helpful in treating p. boydii keratitis.
Effects of different plasma target concentrations of remifentanil on the MACBAR of sevoflurane in children with laparoscopic surgery
Authors: Wang Dan , Xu Juan , Yang Xiao-Lin , Guo Yan-Xia , Jiang Ping-Ping , Zhang Guo-Yuan 
Published: September 2021

Abstract
Background
To investigate the effects of different plasma target concentrations of remifentanil on the minimum alveolar concentration (MAC) for blocking adrenergic response (BAR) of sevoflurane in children with laparoscopic herniorrhaphy.

Methods
Seventy-five children with 3-7 years old scheduled for laparoscopic herniorrhaphy were randomly divided into group R0, group R1, and group R2 according to different remifentanil plasma target concentration (0, 1, and 2 ngml-1), respectively. The MACBAR of sevoflurane was determined by the up-and-down and sequential method in each group. The concentrations of epinephrine and noradrenaline were also determined at corresponding time points.

Results
A total of 52 child patients were used among the anticipated 75 patients. In groups R0, R1, and R2, the MACBAR of sevoflurane was (3.29 ± 0.17) %, (2.12 ± 0.10) % and (1.29 ± 0.11) %, respectively, and a significant difference was found among the three groups (P<0.05). The changes of epinephrine and noradrenaline concentrations in each group before and after insufflation of carbon dioxide pneumoperitoneum showed no significant differences.

Conclusion
Remifentanil by target-controlled infusion can effectively reduce the MACBAR of sevoflurane during laparoscopic surgery in children. At a similar effect of MACBAR, both the changes of epinephrine and noradrenaline concentrations are not affected by the infusion of different remifentanil target concentrations.

Trial registration
The trial was registered at http://www.chictr.org.cn(ChiCTR1800019393, 8, Nov, 2018).
Effects of low-frequency repetitive transcranial magnetic stimulation combined with cerebellar continuous theta burst stimulation on spasticity and limb dyskinesia in patients with stroke
Authors: Li Dawei , Cheng Aixia , Zhang Zhiyou , Sun Yuqian , Liu Yingchun 
Published: September 2021

AbstractBackgroundRepetitive transcranial magnetic stimulation (rTMS) has been reported to treat muscle spasticity in post-stroke patients. The purpose of this study was to explore whether combined low-frequency rTMS (LF-rTMS) and cerebellar continuous theta burst stimulation (cTBS) could provide better relief than different modalities alone for muscle spasticity and limb dyskinesia in stroke patients.MethodsThis study recruited ninety stroke patients with hemiplegia, who were divided into LF-rTMS+cTBS group (n=30), LF-rTMS group (n=30) and cTBS group (three pulse bursts at 50 Hz, n=30). The LF-rTMS group received 1 Hz rTMS stimulation of the motor cortical (M1) region on the unaffected side of the brain, the cTBS group received cTBS stimulation to the cerebellar region, and the LF-rTMS+cTBS group received 2 stimuli as described above. Each group received 4 weeks of stimulation followed by rehabilitation. Muscle spasticity, motor function of limb and activity of daily living (ADL) were evaluated by modified Ashworth Scale (MAS), Fugl-Meyer Assessment (FMA) and Modified Barthel Index (MBI) scores, respectively.ResultsThe MAS score was markedly decreased, FMA and MBI scores were markedly increased in the three groups after therapy than before therapy. In addition, after therapy, LF-rTMS+cTBS group showed lower MAS score, higher FMA and MBI scores than the LF-rTMS group and cTBS group.ConclusionMuscle spasticity and limb dyskinesia of the three groups are all significantly improved after therapy. Combined LF-rTMS and cTBS treatment is more effective in improving muscle spasticity and limb dyskinesia of patients after stroke than LF-rTMS and cTBS treatment alone.
Cultural adaptation of the mental health first aid guidelines for assisting a person at risk of suicide for Sri Lanka: a Delphi expert consensus study
Authors: Chandrasiri Amila , Fernando Madhawee , Dayabandara Madhubhashinee , Reavley Nicola J. 
Published: September 2021

Abstract
Background
Approximately 3000 people die by suicide each year in Sri Lanka. As family and friends may play a role in supporting a person at risk of suicide to get appropriate help, there is a need for evidence-based resources to assist with this. The aim of this study was to culturally adapt the existing English-language mental health first aid guidelines for helping a person at risk of suicide to the Sri Lankan context.

Methods
A Delphi expert consensus study was conducted, involving mental health professionals and consumers (people with lived experience) and caregivers, who were identified by purposive and snowball sampling methods. Participants were recruited from a wide variety of professional roles and districts of Sri Lanka in order to maximize diversity of opinion. The original questionnaire was translated into Sinhala and participants were requested to rate each item according to the importance of inclusion in the guidelines.

Results
Data were collected over two survey rounds. Altogether, 148 people participated in the study (130 health professionals and 18 consumers). A total of 165 items were included in the final guidelines, with 153 adopted from the guidelines for English-speaking countries and 12 generated from the comments of panellists.

Conclusions
The adapted guidelines were similar to the English-language guidelines. However, new items relating to the involvement of family members were included and some items were omitted because they were not considered appropriate to the Sri Lankan context (particularly those relating to explicit mention of suicide). Further research is warranted to explore the use of these guidelines by the Sri Lankan public, including how they may be incorporated in Mental Health First Aid training.
Physical fighting among adolescents in eastern Ethiopia: a cross-sectional study
Authors: Semahegn Agumasie , Dessie Yadeta , Assefa Nega , Canavan Chelsey R. , Berhane Yemane , Fawzi Wafaie W. 
Published: September 2021

Abstract
Background
Physical fights have been a common health problem among adolescents, and approximately a million adolescents’ lives are lost due to violence-related incidents worldwide. There is a lack of information on the burden of adolescents’ physical fights in eastern Ethiopia. Hence, the study aims to estimate the magnitude and assess factors associated with physical attacks and fighting among adolescents in eastern Ethiopia.

Methods
A community-based cross-sectional study was conducted among 2424 adolescents in eastern Ethiopia in 2016. Simple random sampling was used to recruit study participants. Data were collected by trained interviewers using a structured questionnaire developed by the Africa Research, Implementation Science and Education (ARISE) network and adapted from the World Health Organization Global school-based student health survey. Descriptive statistics, binary and multivariable logistic regression were performed. Statistical associations were determined using adjusted odds ratio (AOR) at 95% Confidence Intervals (95% CIs) and P-value < 0.05.

Results
Prevalence of physical attacks and physical fights was 5.8%, and 26.4%, respectively. Adolescents who attended school (AOR 0.4, 95% CI: 0.2–0.9) and who chewed Khat (AOR 0.4, 95% CI: 0.2–0.8) were less likely to experience physical attacks. Male adolescents were two times more likely to engage in physical fights than female adolescents (AOR 2.4, 95% CI: 1.8–3.2). In-school adolescents who attended secondary (AOR 0.4, 95% CI: 0.2–0.7) or tertiary level of education (AOR 0.2, 95% CI: 0.1–0.7) were less likely to participate in physical fighting than those with primary level education. Adolescents who had ever engaged in physical work to earn money for food or drink were 1.9 times more likely to be physically attacked compared to those who had not (AOR 1.9, 95% CI: 1.0–3.5).

Conclusion
Physical attacks and fights were found to be common experiences of adolescents in eastern Ethiopia. Future research and programs should emphasize preventive health programs for reducing violence and promoting school enrolment and retention.