bluuebunny/crossref_metadata_2025_split huggingface dataset:
Two-Stage Single-Arm Trials Are Rarely Analyzed Effectively or Reported Adequately
Authors: Grayling Michael J. , Mander Adrian P. 
Published: December 2021

PURPOSE Two-stage single-arm designs have historically been the most common design used in phase II oncology. They remain a mainstay today, particularly for trials in rare subgroups. Consequently, it is imperative such studies be designed, analyzed, and reported effectively. We comprehensively review such trials to examine whether this is the case. METHODS Oncology trials that used Simon's two-stage design over a 5-year period were identified and reviewed. They were evaluated for whether they reported sufficient design (eg, required sample size) and analysis (eg, CI) details. Articles that did not adjust their inference for the incorporation of an interim analysis were also reanalyzed. RESULTS Four-hundred twenty-five articles were included. Of these, just 47.5% provided the five components that ensure design reproducibility. Only 1.2% and 2.1% reported an adjusted point estimate or CI, respectively. Just 55.3% provided the final stage rejection bound, indicating many trials did not test a hypothesis for their primary outcome. Trial reanalyses suggested reported point estimates underestimated treatment effects and reported CIs were too narrow. CONCLUSION Key design details of two-stage single-arm trials are often unreported. Their inference is rarely performed such as to remove bias introduced by the interim analysis. These findings are particular alarming when considered against the growing trend in which nonrandomized trials make up a large proportion of all evidence on a treatment's effectiveness in a rare biomarker-defined patient subgroup. Future studies must improve the way they are analyzed and reported.
Airway Ultrasound as Predictor of Difficult Direct Laryngoscopy: A Systematic Review and Meta-analysis
Authors: Carsetti Andrea , Sorbello Massimiliano , Adrario Erica , Donati Abele , Falcetta Stefano 
Published: December 2021

BACKGROUND:
Despite several clinical index tests that are currently applied for airway assessment, unpredicted difficult laryngoscopy may still represent a serious problem in anesthesia practice. The aim of this systematic review and meta-analysis was to evaluate whether preoperative airway ultrasound can predict difficult direct laryngoscopy in adult patients undergoing elective surgery under general anesthesia.

METHODS:
We searched the Medline, Scopus, and Web of Science databases from their inception to December 2020. The population of interest included adults who required tracheal intubation for elective surgery under general anesthesia without clear anatomical abnormalities suggesting difficult laryngoscopy. A bivariate model has been used to assess the accuracy of each ultrasound index test to predict difficult direct laryngoscopy.

RESULTS:
Fifteen studies have been considered for quantitative analysis of summary receiver operating characteristic (SROC). The sensitivity for distance from skin to epiglottis (DSE), distance from skin to hyoid bone (DSHB), and distance from skin to vocal cords (DSVC) was 0.82 (0.74–0.87), 0.71 (0.58–0.82), and 0.75 (0.62–0.84), respectively. The specificity for DSE, DSHB, and DSVC was 0.79 (0.70–0.87), 0.71 (0.57–0.82), and 0.72 (0.45–0.89), respectively. The area under the curve (AUC) for DSE, DSHB, DSVC, and ratio between the depth of the pre-epiglottic space and the distance from the epiglottis to the vocal cords (Pre-E/E-VC) was 0.87 (0.84–0.90), 0.77 (0.73–0.81), 0.78 (0.74–0.81), and 0.71 (0.67–0.75), respectively. Patients with difficult direct laryngoscopy have higher DSE, DSVC, and DSHB values than patients with easy laryngoscopy, with a mean difference of 0.38 cm (95% confidence interval [CI], 0.17–0.58 cm; P = .0004), 0.18 cm (95% CI, 0.01–0.35 cm; P = .04), and 0.23 cm (95% CI, 0.08–0.39 cm; P = .004), respectively.

CONCLUSIONS:
Our study demonstrates that airway ultrasound index tests are significantly different between patients with easy versus difficult direct laryngoscopy, and the DSE is the most studied index test in literature to predict difficult direct laryngoscopy. However, it is not currently possible to reach a definitive conclusion. Further studies are needed with better standardization of ultrasound assessment to limit all possible sources of heterogeneity.
Play a Trick and Get a Queen: “Divine Tricksters” in Ancient Korea (and Beyond)
Authors: Riotto Maurizio 
Published: December 2021

Abstract
The issue of trickster in old Korean literature has yet to be discussed in a broadly comparative way in a scientific context. Using a structuralist approach, this article addresses the anthropological theme of the “divine trickster” in some stories from ancient Korea and the ancient West. In particular, by examining three famous episodes from Korean folklore alongside three cases from Western fantastic literature, this article investigates the strategies aimed at acquiring the feminine element as represented by high-ranking foreign women. Starting with the hunting mentality of prehistoric society, where man tries to prevail with intelligence over his prey, the article reviews literary episodes from different anthropological contexts (Indo-European societies, Semitic societies of the Near East, and ancient Korean society), underlining their similarities and differences, but always highlighting and emphasizing the presence of a divine trickster. Ultimately, together with the common denominator of the progressive masculinization of the various societies, we note a more passive role of women in the Korean stories, which appear to be of more recent codification than their Western counterparts, and therefore seem more inspired by cultural patterns of patriarchal orientation.
Turning Songs into Poems and Poems into Songs: Intersections of Literary Sinitic and Vernacular Korean in Chosŏn Literature
Authors: Han Christina 
Published: December 2021

Abstract
This article investigates the dynamic intersections of Literary Sinitic and vernacular Korean and their impact on the innovations in poetry and song in fifteenth- through nineteenth-century Chosŏn Korea. More specifically, it traces the evolution of poetry or song discourse and explores the different strategies employed by Chosŏn poets and songwriters to render oral songs into text. It also investigates the differing views on the function of poetry and song, musical and textual preservation, and emotional and lyrical immediacy, which influenced the composition and translation of song-poems. The article probes the creative collaboration and competition between Literary Sinitic and vernacular Korean, and the fluid relations between translation and vernacularization. On the whole, it explores the ways in which the evolution of poetry-song discourse and the ensuing literary innovations contributed to Chosŏn's complex linguistic ecology.
Avoiding the Radial Paradox: Neuroendovascular Femoral Access Outcomes After Radial Access Adoption
Authors: Wilkinson D. Andrew , Majmundar Neil , Catapano Joshua S. , Cole Tyler S. , Baranoski Jacob F. , Hendricks Benjamin K. , Cavalcanti Daniel D. , Frederickson Vance L. , Ducruet Andrew F. , Albuquerque Felipe C. 
Published: December 2021

BACKGROUND:
Transradial access (TRA) for neuroendovascular procedures is increasing in prevalence. The safety benefits of TRA at a patient level may be offset at a population level by a paradoxical increase in transfemoral access (TFA) vascular access site complications (VASCs), the so-called “radial paradox.”

OBJECTIVE:
To study the effect of TRA adoption on TFA performance and outcomes in neuroendovascular procedures.

METHODS:
Data were collected for all procedures performed over a 10-mo period after radial adoption at a single center.

RESULTS:
Over the study period, 1084 procedures were performed, including 719 (66.3%) with an intent to treat by TRA and 365 (33.7%) with an intent to treat by TFA. Thirty-two cases (4.4%) crossed over from TRA to TFA, and 2 cases (0.5%) crossed over from TFA to TRA. TFA was performed in older patients (mean [standard deviation] TFA, 63 [15] vs TRA, 56 [16] years) using larger sheath sizes (≥7 French; TFA, 56.2% vs TRA, 2.3%) (P < .001 for both comparisons). Overall, 29 VASCs occurred (2.7%), including 27 minor (TFA, 4.6% [18/395] vs TRA, 1.3% [9/689], P = .002) and 2 major (TFA, 0.3% [1/395] vs TRA, 0.1% [1/689], P > .99) complications. Independent predictors of VASC included TFA (OR 2.8, 95% confidence interval [CI] 1.1-7.4) and use of dual antiplatelet therapy (OR 4.2, 95% CI 1.6-11.1).

CONCLUSION:
TFA remains an important access route, despite a predominantly radial paradigm, and is disproportionately used in patients at increased risk for VASCs. TFA proficiency may still be achieved in predominantly radial practices without an increase in femoral complications.
Multiple regions within junctin drive its interaction with calsequestrin-1 and its localization to triads in skeletal muscle
Authors: Rossi Daniela , Lorenzini Stefania , Pierantozzi Enrico , Van Petegem Filip , Osamwonuyi Amadsun David , Sorrentino Vincenzo 
Published: December 2021

ABSTRACT
Junctin is a transmembrane protein of striated muscles, located at the junctional sarcoplasmic reticulum (SR). It is characterized by a luminal C-terminal tail, through which it functionally interacts with calsequestrin and the ryanodine receptor (RyR). Interaction with calsequestrin was ascribed to the presence of stretches of charged amino acids (aa). However, the regions able to bind calsequestrin have not been defined in detail. We report here that, in non-muscle cells, junctin and calsequestrin assemble in long linear regions within the endoplasmic reticulum, mirroring the formation of calsequestrin polymers. In differentiating myotubes, the two proteins colocalize at triads, where they assemble with other proteins of the junctional SR. By performing GST pull-down assays with distinct regions of the junctin tail, we identified two KEKE motifs that can bind calsequestrin. In addition, stretches of charged aa downstream these motifs were found to also bind calsequestrin and the RyR. Deletion of even one of these regions impaired the ability of junctin to localize at the junctional SR, suggesting that interaction with other proteins at this site represents a key element in junctin targeting.
Knowledge and perception of Sepsis among Doctors in Karachi Pakistan
Authors: Ahmed Faiza , Abbasi Lubna , Herekar Fivzia , Jiwani Ahsun , Junaid Patel Muhammad 
Published: December 2021

Objectives: To assess knowledge and perception among Pakistani physicians towards sepsis.
Methods: This cross-sectional study was conducted in Indus Hospital and Health Networks from September 2020 to March 2021. The International Sepsis Survey questionnaire was adapted, and its link was sent to trainee physicians as well as specialists, and consultants practicing in various hospitals via social media. Knowledge and perception were scored and 50% was considered the cut-off score for adequacy. Data was analyzed using SPSS version 26.
Results: Analysis was done on 222 respondents who completed the survey. 37.9% of the participants had adequate knowledge. Knowledge regarding sepsis was significantly associated with specialty, ICU/CCU/HDU, and work experience (P-value <0.0001). More recent trainee physicians and those with more experience in critical care areas demonstrated better knowledge. Over 2/3rd of the respondents strongly agreed that sepsis remains one of the unmet needs in critical care today.
Conclusion: A common belief exists that sepsis remains a challenge to treat among doctors. Moreover, there is consensus that it is the most frequently miss diagnosed condition in critical care and a dire need exists for its early diagnosis. Additionally, prompt management of presumed sepsis is imperative to improve outcomes.
doi: https://doi.org/10.12669/pjms.38.ICON-2022.5775
How to cite this:Ahmed F, Abbasi L, Herekar F, Jiwani A, Patel MJ. Knowledge and perception of Sepsis among Doctors in Karachi Pakistan. Pak J Med Sci. 2022;38(2):380-386. doi: https://doi.org/10.12669/pjms.38.ICON-2022.5775
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Voice against tobacco: A call for integrated action for effective change
Authors: Saeed Saima , Shahroz Inayat Muhammad , Khan Suniya Umar , Agha Alina Ally 
Published: December 2021

doi: https://doi.org/10.12669/pjms.38.ICON-2022.5788
How to cite this:Saeed S, Shahroz IM, Khan SU, Agha AA. Voice against tobacco: A call for integrated action for effective change. Pak J Med Sci. 2022;38(2):436-437. doi: https://doi.org/10.12669/pjms.38.ICON-2022.5788
An ecological study on the association between early childhood caries and intimate partner violence in 20 low- and middle-income countries: 2007-2017
Authors: Folayan Morenike Oluwatoyin , Obiyan Mary O. , El Tantawi Maha , Kemoli Arthur , Al-Batayneh Ola B. , Gaffar Balgis , Schroth Robert J. ,   Early Childhood Caries Advocacy Group
Published: December 2021

Background:Women are the worst affected by intimate partner violence (IPV), and this impacts negatively on the health of the children they care for. This study aimed to determine the relationship between IPV and the prevalence of early childhood caries (ECC) in 3-5-year-olds.Methods:This was an ecological study using IPV (physical, sexual, emotional) data extracted from the Demographic Health Survey of 20 low- and middle-income countries and ECC data for 3-5-year-olds of the same countries for the period 2007-2017. Linear regression analysis was used to assess the relationship between the percentage of 3-5-year-olds with ECC (outcome variable) and IPV indicators (physical, sexual, emotional). The model was adjusted for the country’s gross national income and the percentage of women with secondary or higher education. Partial eta squared (ηp2), regression coefficients, confidence intervals and p-values were calculated.Results:Data on ECC in 3-5-year-olds and IPV were available for six low-income-countries, 10 lower-middle-income-countries and four upper-middle-income-countries. The most prevalent form of IPV was physical violence (10.09%). The Democratic Republic of Congo had the highest prevalence of physical violence (45.8%), sexual violence (25.4%), and ECC (80.0%). The strongest association was between the prevalence of ECC and emotional violence (ηp2=0.01), followed by physical violence (ηp2=0.005), and sexual violence (ηp2=0.003). For every 1% higher prevalence of emotional violence, there was 0.28% higher prevalence of ECC, and for every 1% higher percentage of physical violence, there was 0.21% higher prevalence of ECC. On the contrary, for every 1% higher prevalence of sexual violence, there was 0.35% lower prevalence of ECC prevalence.Conclusions:The association between IPV and the prevalence of ECC in 3-5-year-olds is minor, with the strongest direct association effect being with emotional violence; and there was an inverse association between sexual violence and the prevalence of ECC. These findings need to be studied further.
Student teachers' perceptions of the collaborative relationships form between universities and inclusive elementary schools in Indonesia
Authors: Rasmitadila Rasmitadila , Humaira Megan Asri , Rachmadtullah Reza 
Published: December 2021

Background: The collaborative relationship between universities and inclusive elementary schools has not been maximally practiced. The form of collaboration that universities with inclusive elementary schools have carried out is still limited to the need to complete lecture materials in the semester. There is a gap between the theory and practice obtained by student teachers at universities when they have to teach in inclusive elementary schools. As a result, they have not contributed to solving problems that occur in inclusive elementary schools. The collaborative relationship between inclusive elementary schools and universities directly implies that the success of inclusive education is determined by the competence of student teachers whose universities have successfully educated them in order to teach in inclusive elementary schools. Against the background that the inclusive education system is developing in Indonesia, the researchers investigated student teachers' perceptions at universities about inclusive university-inclusive elementary school collaborative relationships. Methods: During data collection, an online survey and in-depth interviews of student teachers about individual experiences and their ideas about the form of inclusive elementary schools-university partnerships was conducted. The data analysis used is a thematic analysis technique. Result: The result summarizes student teachers' statements, revealed three main themes: provision of inclusive education needs, research, and field practice. The student teachers revealed that the collaborative relationship between universities and inclusive elementary schools is essential to develop holistic, inclusive practices in a collaborative partnership based on input-needs, which has a two-way impact or benefit for both parties. Conclusions: Furthermore, collaborative relationships must be in the form of long-term programs, such as continuous assistance, and adaptation to the development of inclusive education through lecture materials. To achieve inclusive education in Indonesia, we also recommend that the government make policies on multi-sectoral collaboration in order to support inclusive education.
Mental health following an initial period of COVID-19 restrictions: findings from a cross-sectional survey in the Republic of Ireland
Authors: Troya Maria Isabela , Joyce Mary , Khashan Ali , Buckley Claire , Chakraborti Kasturi , Hoevel Philipp , Humphries Rory , Kearney Patricia M. , Kiely Elizabeth , Murphy Mike , Perry Ivan , Arensman Ella 
Published: December 2021

Background: We assessed the mental health of individuals in the general population, during an initial period of easing of COVID-19 restrictions in the Republic of Ireland (RoI). Methods: Data were collected through a nationally representative cross-sectional telephone survey, during the first period of easing of restrictions during the COVID-19 pandemic between May and July 2020. Mental health was examined using the Patient Health Questionnaire Anxiety Depression Scale. Poisson regression analyses were conducted to estimate risk ratios with robust variance estimation of the association between selected demographic factors and the risk of having depression and anxiety symptoms. Results: Of the 1,983 participants, 27.7% (n = 549; 95% CI: 0.26 - 0.30) reported depression and anxiety symptoms, while 74 (3.8%; 95% CI: 0.03 - 0.05) disclosed self-harm and/or suicidal thoughts. Females (RR: 1.60, 95% CI: 1.37 - 1.87, p < 0.0005), employed individuals who experienced a change in work status (RR: 1.50, 95% CI: 1.24 - 1.82, p < 0.0005), participants cocooning due to a health condition (RR: 1.34, 95% CI: 1.08 - 1.66, p< 0.01), participants who were self-isolating (RR: 1.25, 95% CI: 1.03 - 1.51, p=0.025) and moderate-heavy drinkers (RR: 1.27, 95% CI: 1.09 - 1.47, p<0.01) were at increased risk of depression and anxiety. Young people aged 18-29 years and those in the two lowest income categories were most likely to report self-harm and/or suicidal thoughts. Conclusion: As the COVID-19 pandemic continues, with further waves and associated restrictions, the impact on mental health in the population as a whole and in specific subgroups must be considered. Study protocol registration: doi.org/10.12688/hrbopenres.13103.2
Discrepancies between two long-term dietary datasets in the United Kingdom (UK)
Authors: Smith Kerry G. , Scheelbeek Pauline , Balmford Andrew , Garnett Emma E. 
Published: December 2021

Background: Studying dietary trends can help monitor progress towards healthier and more sustainable diets but longitudinal data are often confounded by lack of standardized methods. Two main data sources are used for longitudinal analysis of diets: food balance sheets on food supply (FBS) and household budget surveys on food purchased (HBS). Methods: We used UK longitudinal dietary data on food supply, provided by the Food and Agriculture Organisation (FAO) (FAO-FBS, 1961-2018), and food purchases, provided by Defra (Defra-HBS, 1942-2018). We assessed how trends in dietary change per capita compared between FAO-FBS and Defra-HBS for calories, meat and fish, nuts and pulses, and dairy, and how disparities have changed over time. Results: FAO-FBS estimates were significantly higher (p<0.001) than Defra-HBS for calorie intake and all food types, except nuts and pulses which were significantly lower (p<0.001). These differences are partly due to inclusion of retail waste in FAO-FBS data and under-reporting in Defra- HBS data. The disparities between the two datasets increased over time for calories, meat and dairy; did not change for fish; and decreased for nuts and pulses . Between 1961 and 2018, both FAO-FBS and Defra-FBS showed an increase in meat intake (+11.5% and +1.4%, respectively) and a decrease in fish (-3.3% and -3.2%, respectively) and dairy intake (-11.2% and -22.4%). Temporal trends did not agree between the two datasets for calories, and nuts and pulses. Conclusions: Our finding raises questions over the robustness of both data sources for monitoring UK dietary change, especially when used for evidence-based decision making around health, climate change and sustainability.