bluuebunny/crossref_metadata_2025_split huggingface dataset:
Serious incidents in testicular torsion management in England, 2007–2019: optimizing individual and training factors are the key to improved outcomes
Authors: Menzies‐Wilson Richard , Folkard Samuel S. , Sevdalis Nick , Green James S.A. 
Published: March 2021

ObjectivesTo establish the healthcare factors that contribute to testicular torsion adverse events (orchidectomies) and 'near misses'. The secondary objective was to identify areas suitable for impactful quality improvement initiatives to be undertaken by National Health Service (NHS) healthcare providers nationally.Materials and MethodsThis was a retrospective record review and analysis, carried out in four phases. We applied the well‐validated London Protocol patient safety incident analysis framework to all eligible serious incidents related to testicular torsion submitted by English NHS Trusts over a 12‐year period to the Strategic Executive Information System database. Clinical reviewers established the incident population (Phase 1), were trained and piloted the feasibility of using the London Protocol (Phase 2), applied the protocol and themed the identified contributing factors linked to adverse events (orchidectomies) and near‐misses (Phase 3), and reviewed the evidence for improvement interventions (Phase 4).ResultsOur search returned 992 serious incidents, of which 732 were eligible for study inclusion and analysis. Of those, 137 resulted in orchidectomies, equivalent to one serious incident resulting in orchidectomy per month, and 595 were near misses. Factors contributing to all incidents were: individual staff/training (38%); team (18%); work environment (16%); task and technology (14%); and institutional context (13%). Subgroup analysis of incidents resulting in orchidectomies vs near misses demonstrated a different pattern of factors, with individual staff/training factors significantly more prominent: individual/training (88%); work environment (8%); and task and technology (1%). No evidenced improvement interventions were found in the literature.ConclusionThis is the first study to our knowledge to systematically analyse and classify factors that are associated with loss of a testicle and related near‐miss incidents in patients presenting with testicular torsion. In England, a significant number of orchidectomies occur annually as a consequence of healthcare serious incidents. In order to improve outcomes, we propose clinical support to aid the diagnosis of torsion, improved national clinical guidelines, development of specific standard operating procedures and (in the longer term) more exposure of trainees and medical students to urology to improve the testicular salvage rate.
Screen time use impacts low‐income preschool children's sleep quality, tiredness, and ability to fall asleep
Authors: Waller Nicole A. , Zhang Nanhua , Cocci Adrienne H. , D'Agostino Crystal , Wesolek‐Greenson Sarah , Wheelock Kevin , Nichols Lauren P. , Resnicow Ken 
Published: March 2021

AbstractBackgroundSleep is increasingly recognized as a vital part of health. Screen time has been linked to sleep quality in children. The purpose of this study was to analyze associations between screen time and sleep characteristics among low‐income preschoolers.MethodsA total of 1,700 preschool‐aged children participated in this study at 50 federally and state‐funded preschool centers in Michigan. Baseline measurement for an ongoing longitudinal intervention trial was obtained for cross‐sectional use. At baseline, parents reported the number of hours their child spent engaging in screen time on a typical week day and weekend. An aggregate measure of total screen time was created. Parents reported on the quality of their child's sleep, how often they were tired during the day, and whether they had difficulty falling asleep. A mixed model linear regression was created to analyze data.ResultsControlling for child's age, race, and parental income, children who engaged in more screen time were significantly more likely to have more trouble falling or staying asleep, be tired during the day, and had worse quality of sleep (P values = .004, .006 and .001, respectively). Spearman correlations of screen time, sleep variables and demographics show parents of Black children reported significantly higher weekly screen time than parents of non‐Black children (r = 0.23, P < .001) and that tiredness was associated with Black race (r = 0.15, P < .001), Hispanic/Latino ethnicity (r = −0.14, P < .001), and parental education (r = 0.06, P = .016).ConclusionThis report confirms prior associations between screen time and sleep reported in other pediatric populations. Further research is needed to confirm these results in other populations using more rigorous measures of screen time, sleep, and physical activity, as well as longitudinal assessments. Despite these limitations, findings suggest that interventions to help parents limit children's screen time and impact their sleep health merit investigation.
Current status of diagnostic and therapeutic colonoscopy in Japan: The Japan Endoscopic Database Project
Authors: Saito Yutaka , Kodashima Shinya , Matsuda Takahisa , Matsuda Koji , Fujishiro Mitsuhiro , Tanaka Kiyohito , Kobayashi Kiyonori , Katada Chikatoshi , Horimatsu Takahiro , Muto Manabu , Ohtsuka Kazuo , Oda Ichiro , Kato Masayuki , Kida Mitsuhiro , Hoteya Shu , Yamamoto Hironori , Ryozawa Shomei , Iwakiri Ryuichi , Kutsumi Hiromu , Kato Mototsugu , Haruma Ken , Fujimoto Kazuma , Iishi Hiroyasu , Ogata Haruhiko , Uemura Naomi , Kaminishi Michio , Tajiri Hisao , Inoue Haruhiro 
Published: March 2021

ObjectivesThe Japan Endoscopy Database Project was initiated to develop the world’s largest endoscopy data repository. This study describes the first phase of the colonoscopy project in Japan.MethodsData were aggregated offline by integrating information from the endoscopy database software from January 2015 through March 2017. The study population included all patients who underwent colonoscopy at eight centers.ResultsA total of 31,395 patients who underwent 38,497 colonoscopy procedures were registered. The majority of procedures were performed for screening (n = 14,156), followed by fecal immunochemical test positivity (n = 3960), abdominal symptoms (n = 3864), post‐colorectal surgery surveillance (n = 3431), post‐endoscopic treatment surveillance (n = 3757), thorough pre‐treatment examination (n = 2822), and therapeutic purposes (n = 6507). In the screening group, advanced cancers, early cancers, and adenomas were diagnosed endoscopically in 2.1%, 1.3%, and 28.7% of cases, respectively, while in the fecal immunochemical test‐positive group, they were diagnosed in 2.5%, 1.9%, and 41.6% of cases, respectively. The incidence of complications was 0.177% and 0.152% in the screening and fecal immunochemical test‐positive groups, respectively. The therapeutic procedures included 1446 cold forceps polypectomy procedures, 4770 cold snare polypectomy procedures, 368 hot biopsies, 2998 hot snare polypectomy procedures, 9775 endoscopic or piecemeal endoscopic mucosal resections, and 1660 endoscopic submucosal dissections. A total of 173 procedure‐related complications (0.82%) occurred in 21,017 therapeutic procedures performed in 15,744 patients.ConclusionsThe first phase of the Japan Endoscopy Database Project established the proportions of the diagnostic and therapeutic colonoscopy procedures, and complication rates in real‐world settings.
Insulin resistance in type 1 diabetes managed with metformin (INTIMET): Study protocol of a double‐blind placebo‐controlled, randomised trial
Authors: Snaith Jennifer R. , Samocha‐Bonet Dorit , Evans Jennifer , Liu Zhixin , Kowalski Greg , Bruce Clinton , Holmes‐Walker Deborah J. , Greenfield Jerry R. 
Published: March 2021

AbstractBackgroundInsulin resistance is an under‐recognised metabolic defect and cardiovascular risk factor in Type 1 diabetes. Whether metformin improves hepatic, muscle or adipose tissue insulin sensitivity has not been studied in adults with Type 1 diabetes. We initiated the INTIMET study (INsulin resistance in Type 1 diabetes managed with METformin), a double‐blind randomised, placebo‐controlled trial to measure the effect of metformin on tissue‐specific insulin resistance in adults with Type 1 diabetes.MethodsWe will study 40 adults aged 20–55 years with Type 1 diabetes (HbA1c 80 mmol/mol [9.5%], fasting C‐peptide <0.3 nmol/L) and 20 age‐, gender‐ and body mass index (BMI)‐matched controls. Insulin sensitivity will be determined by the two‐step hyperinsulinaemic‐euglycaemic clamp method with deuterated glucose to document liver, muscle and adipose insulin sensitivity. Subjects with Type 1 diabetes will be randomised to metformin extended‐release 1500 mg daily or matched placebo for 26 weeks. The primary outcome is change in hepatic insulin sensitivity, assessed by change in basal rate of appearance (Ra) of glucose and suppression of endogenous glucose production (EGP) during the low‐dose stage of the clamp.ConclusionThe INTIMET study is the first clinical trial to quantify the impact of metformin on liver, muscle and adipose insulin resistance in adults with Type 1 diabetes. This study may identify factors that predict an individual's response to metformin in Type 1 diabetes. Trial Registration: ACTRN12619001440112.
Hypoglycaemia and diabetes‐specific quality of life in adolescents with type 1 diabetes
Authors: Coolen Manon , Aalders Jori , Broadley Melanie , Aanstoot Henk‐Jan , Hartman Esther , Hendrieckx Christel , Nefs Giesje , Pouwer Frans 
Published: March 2021

AbstractAimsTo examine whether frequency, perceived severity and fear of hypoglycaemia are independently associated with diabetes‐specific quality of life in adolescents with type 1 diabetes.MethodsCross‐sectional self‐reported data on demographics, frequency and perceived severity of both self‐treated and severe hypoglycaemia, fear of hypoglycaemia (Hypoglycaemia Fear Survey—Child version) and diabetes‐specific quality of life (Pediatric Quality of Life Diabetes Module; PedsQL‐DM) were obtained from the project ‘Whose diabetes is it anyway?’. Hierarchical regression analyses were performed for the total scale and recommended summary scores of the PedsQL‐DM as dependent variables; independent variables were entered in the following steps: (1) age, gender and HbA1c, (2) frequency of hypoglycaemia, (3) perceived severity of hypoglycaemia and (4) fear of hypoglycaemia.ResultsAdolescents (12–18 years; n = 96) completed questionnaires. In the first three steps, female gender (p < 0.05), higher HbA1c (p < 0.05), higher frequency of severe hypoglycaemia (p < 0.05) and higher perceived severity of severe (p < 0.05) and self‐treated hypoglycaemia (p < 0.001) were significantly associated with lower diabetes‐specific quality of life (β ranging from 0.20 to 0.35). However, in the final model only fear of hypoglycaemia was significantly associated with QoL (p < 0.001). Adolescents with greater fear reported lower diabetes‐specific quality of life, with 52% explained variance. This pattern was observed across subdomains of diabetes‐specific quality of life.ConclusionsFear of hypoglycaemia was the only factor independently associated with diabetes‐specific quality of life, whereas frequency and perceived severity of hypoglycaemia were not. These findings highlight the importance of awareness and assessment of fear of hypoglycaemia in clinical practice.
Patient and paramedic experiences with a direct electronic referral programme for focused hypoglycaemia education following paramedic service assist‐requiring hypoglycaemia in London and Middlesex County, Ontario, Canada
Authors: Liu Selina L. , Sibbald Shannon L. , Rosa Andrew , Mahon Jeffrey L. , Carter Dustin R. , Peddle Michael , Spaic Tamara 
Published: March 2021

AbstractAimsHypoglycaemia is a common treatment consequence in diabetes mellitus. Prior studies have shown that a large proportion of people with paramedic assist‐requiring hypoglycaemia prefer not to be transported to hospital. Thus, these episodes are “invisible” to their usual diabetes care providers. A direct electronic referral programme where paramedics sent referrals focused hypoglycaemia education at the time of paramedic assessment was implemented in our region for 18 months; however, referral programme uptake was low. In this study, we examined patient and paramedic experiences with a direct electronic referral programme for hypoglycaemia education postparamedic assist‐requiring hypoglycaemia, including barriers to programme referral and education attendance.MethodsWe surveyed paramedics and conducted semistructured telephone interviews of patients with paramedic‐assisted hypoglycaemia who consented to the referral programme and were scheduled for an education session in London and Middlesex County, Canada.ResultsParamedics and patient participants felt that the direct referral programme was beneficial. A third of paramedics who responded to our survey used the referral programme for each encounter where they treated patients for hypoglycaemia. Patients felt very positive about the referral programme and their paramedic encounter; however, they described embarrassment, guilt and prior negative experience as key barriers to attending education.ConclusionsParamedics and patients felt that direct referral for focused hypoglycaemia education postparamedic assist‐requiring hypoglycaemia was an excellent strategy. Despite this, referral programme participation was low and thus there remain ongoing barriers to implementation and attendance. Future iterations should consider how best to meet patient needs through innovative delivery methods.
Investment commitments in PTAs and MNCS in partner countries
Authors: Kim Soo Yeon 
Published: March 2021

AbstractThis paper analyzes the impact of investment commitments in preferential trade agreements (PTAs) on multinational firms' production networks. The analysis tests the hypothesis that strong investment commitments in PTAs encourage multinational firms to locate affiliates in agreement partners. Agreement countries are desirable locations for MNCS' production networks because PTAs reduce the costs of information concerning the host countries, provide a common regulatory framework for investment by way of the PTA, and embed investment in a larger package of trade liberalization that facilitates cross‐border movement of intermediate goods. The study employs an original dataset of investment provisions in PTAs that measures the liberalization, protection, and integration in investment activities, and another on the location of multinational firms' subsidiaries. An analysis of 317 PTAs supports the main hypothesis: strong investment commitments in PTAs are associated with a higher number of common MNC affiliates among partner countries, controlling for a host of political and economic factors. This paper contributes to the scholarship on multinational firms' behavior in the post‐agreement phase of PTAs and more broadly on the mapping of trade agreement provisions in key areas of global production.
A meta‐analysis of responses in floral traits and flower–visitor interactions to water deficit
Authors: Kuppler Jonas , Kotowska Martyna M. 
Published: March 2021

AbstractAlterations in water availability and drought events as predicted by climate change scenarios will increasingly impact natural communities with effects already emerging at present. Water deficit leads to increasing physiological stress in plants, likely affecting floral development and causing changes in floral morphology, nectar and pollen production or scent. Understanding how these floral traits are altered by water deficit is necessary to predict changes in plant–pollinator interactions and how communities are impacted in the future. Here we employ a meta‐analysis approach to synthesize the current evidence of experimental water deficit on floral traits and plant–pollinator interactions. Furthermore, we explore experimental factors potentially increasing heterogeneity between studies and provide ideas how to enhance comparability between studies. In the end, we highlight future directions and knowledge gaps for floral traits and plant–pollinator interactions under water deficit. Our analysis showed consistent decreases in floral size, number of flowers and nectar volume to reduced water availability. Other floral traits such as the start of flowering or herkogamy showed no consistent pattern. This indicates that effects of reduced water availability differ between specific traits that are potentially involved in different functions such as pollinator attraction or efficiency. We found no general decreasing visitation rates with water deficit for flower–visitor interactions. Furthermore, the comparison of available studies suggests that increased reporting of plant stress severity and including more hydraulic and physiological measurements will improve the comparability across experiments and aid a more mechanistic understanding of plant–pollinator interactions under altered environmental conditions. Overall, our results show that water deficit has the potential to strongly affect plant–pollinator interactions via changes in specific floral traits. Linking these changes to pollination services and pollinator performance is one crucial step for understanding how changing water availability and drought events under climate change will alter plant and pollinator communities.
Physiological analysis of growth and development of winter carinata (Brassica carinata A. Braun)
Authors: Seepaul Ramdeo , Kumar Shivendra , Boote Kenneth J. , Small Ian M. , George Sheeja , Wright David L. 
Published: March 2021

AbstractBrassica carinata is a non‐food, low‐carbon, none‐to‐low indirect land‐use change impact oilseed feedstock grown for sustainable biofuels, bioproducts, and high protein seed meal. Understanding carinata growth and development is critical to the development of best management practices for maximum productivity and profitability of double‐cropped farming systems. Field experiments were conducted during 2017–2018 (Year 1) and 2018–2019 (Year 2) winter–spring growing seasons in Quincy, Florida, to quantify the total aboveground dry matter accumulation (TDM), allocation, growth, nutrient uptake, and seed quality. The two carinata cultivars Avanza 641 and AX17012 accumulated 10826 and 9343 kg TDM ha−1 in Year 1 and 9655 and 10,642 kg TDM ha−1 in Year 2, respectively, at harvest maturity. The proportion of DM in the vegetative parts such as leaves and stems decreased, and the DM in reproductive structures such as silique walls and seeds increased with maturity. Seed yield (SY) was similar between cultivars but differed between years with Year 1 (2732 kg ha−1), producing 29% greater SY than Year 2 (1929 kg ha−1). Carinata primary stem has 17–20 leaf nodes, with 75%–88% of the axillary meristems producing primary and secondary branches. Crop growth rate (CGR) increased from vegetative to pod development for both cultivars in Year 1, while in Year 2, AX17012 and Avanza 641 attained maximum CGR at the pod development and bolting/flowering stages, respectively. Maximum seasonal nutrient uptake in leaves, stems, and siliques generally occurred in the early, mid, and late season, respectively, in both years. Seed weight, oil, monounsaturated fatty acids, C18:3, C20:1, and C22:1 concentrations increased with plant age, whereas protein, glucosinolate, polyunsaturated fatty acids, saturated fatty acids, C18:1, and C18:2 concentrations decreased with plant maturity. These results can be used for crop modeling to predict growth, development, and yield and aid in developing in‐season decision support tools.
Borehole Heat Exchangers—Addressing the Application Gap with Groundwater Science
Authors: Schincariol Robert A. , Raymond Jasmin 
Published: March 2021

AbstractHydrogeologists and mechanical engineers approach the design of geoexchange systems, and the associated borehole heat exchanger (BHE) fields, in different ways, each focusing on their knowledge areas. While these differences have created a strong research base, with well‐published innovations and designs that collectively allow for sustainable systems, industry has not embraced these recent advancements. Despite abundant research demonstrating how complex shallow groundwater flow and temperature conditions can influence BHE design and operation, the low‐temperature geothermal industry remains largely fixed on simple analytical codes and assumed uniform ground conditions. Geoexchange system inefficiencies become masked via reduced heat pump performance and increased electricity consumption. Similarly, interactions between BHE fields and infrastructure in urban areas are slow to manifest and are often unrealized due to a lack of field temperature data. While regulations that include hydrogeological factors have been developed in some jurisdictions, they are largely voluntary or rudimentary and can be unapplied in industry. Addressing this application gap may be unreasonable as designing and installing thermally efficient geoexchange systems can put them out of the cost envelope of competing heating and cooling systems. Perhaps for hydrogeologists, the way forward lies in the use of BHE's to facilitate contaminated sites remediation, an area we are familiar with, and one that allows for innovative technologies to reduce cost envelopes. Following that path, hydrogeologists can help improve system efficiencies while fully considering the dynamic nature of advective and thermal transport by groundwater.
Diabetes care provided by national standards can improve patients' self‐management skills: A qualitative study of how people with type 2 diabetes perceive primary diabetes care
Authors: Husdal Rebecka , Thors Adolfsson Eva , Leksell Janeth , Nordgren Lena 
Published: March 2021

AbstractBackgroundThe increasing incidence of type 2 diabetes mellitus [T2DM] has resulted in extensive research into the characteristics of successful primary diabetes care. Even if self‐management support and continuity are increasingly recognized as important, there is still a need for deeper understanding of how patients' experiences of continuity of care coincide with their needs for self‐management and/or self‐management support.ObjectiveTo gain a deeper understanding of how people with T2DM perceive Swedish primary diabetes care and self‐management support.MethodsThis qualitative study used focus groups as the means for data collection. Participants were identified through a purposive sampling method differing in age, sex, diabetes duration and latest registered glycated haemoglobin level. Twenty‐eight participants formed five focus groups. Qualitative content analysis was applied to interview transcripts.ResultsThe main theme emerging from the focus group data was that diabetes care provided by national standards improved self‐management skills. Two themes that emerged from the analysis were (a) the importance of a clarification of structures and procedures in primary diabetes care and (b) health‐care staff ‘being there’ and providing support enables trust and co‐operation to enhance self‐management.ConclusionsIndividual patients' self‐management resources are strengthened if the importance of providing relational continuity, management continuity and informational continuity is considered. Patients also need assistance on ‘how’ self‐management activities should be performed.Patient contributionPrior to the study, one pilot focus group was conducted with patients to obtain their perspectives on the content of the planned focus groups; thus, patients were involved in both planning and conduct of the study.