bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of Melatonin and Doxorubicin on Primary Tumor And Metastasis in Breast
Cancer Model
Authors: Tanriover Gamze , Dilmac Sayra , Aytac Gunes , Farooqi Ammad Ahmad , Sindel Muzaffer 
Published: December 2021

Background:
Melatonin exerts oncostatic effects on breast cancer via immunomodulation and antioxidation.
Doxorubicin is an effective chemotherapeutic agent, but parallel studies also provide ample evidence of an
off-target effect of Doxorubicin in breast cancer patients.

Objective:
Combinatorial use of doxorubicin and melatonin has not been comprehensively analyzed in breast cancer
models. We hypothesized that the anti-oxidative, anti-proliferative and anti-inflammatory effects of melatonin could
ameliorate the off-target effects of doxorubicin in breast cancer patients and enhance the anti-tumoral effects of
doxorubicin. The goal of the study is to test this hypothesis in cancer cell lines and xenografted mice.

Methods:
The effects of Melatonin and doxorubicin on the cell viability were evaluated in 4T1-Brain Metastatic Tumor
(4TBM). Furthermore, the effects of melatonin and doxorubicin on the primary tumors and systemic metastasis
were evaluated in the xenografted mice. Lung and liver tissues were removed and metastasis analyses were performed.
The levels of p65, phospho-STAT3, CD11b+, GR1+, Ki67, and cleaved caspase-3 proteins were determined with immunohistochemistry
and western blot analysis. We examined the effects of melatonin and Melatonin+Doxorubicin
combination therapy on 4TBM cells.

Results:
Our results showed that doxorubicin inhibited the proliferation of metastatic breast cancer cells while melatonin
did not affect cells. Tumor growth and metastasis were markedly suppressed in melatonin alone and in combination
with doxorubicin. The expression of CD11b+ and GR1+ proteins, which are indicators of myeloid-derived suppressor
cells (MDSCs), were noted to be reduced in both primary tumor and metastatic tissues in melatonin and doxorubicin
groups.

Conclusion:
The combination of melatonin with doxorubicin reduced primary tumor growth and distant metastasis.
Based on these results, melatonin is a promising candidate for combinatory use with conventional chemotherapeutics
for breast cancer treatment.
An Intelligent Individualized Cardiovascular App for Risk Elimination (iCARE) for Individuals With Coronary Heart Disease: Development and Usability Testing Analysis
Authors: Chen Yuling , Ji Meihua , Wu Ying , Wang Qingyu , Deng Ying , Liu Yong , Wu Fangqin , Liu Mingxuan , Guo Yiqiang , Fu Ziyuan , Zheng Xiaoying 
Published: December 2021

Background
Death and disability from coronary heart disease (CHD) can be largely reduced by improving risk factor management. However, adhering to evidence-based recommendations is challenging and requires interventions at the level of the patient, provider, and health system.

Objective
The aim of this study was to develop an Intelligent Individualized Cardiovascular App for Risk Elimination (iCARE) to facilitate adherence to health behaviors and preventive medications, and to test the usability of iCARE.

Methods
We developed iCARE based on a user-centered design approach, which included 4 phases: (1) function design, (2) iterative design, (3) expert inspections and walkthroughs of the prototypes, and (4) usability testing with end users. The usability testing of iCARE included 2 stages: stage I, which included a task analysis and a usability evaluation (January to March 2019) of the iCARE patient app using the modified Health Information Technology Usability Survey (Health-ITUES); and stage II (June 2020), which used the Health-ITUES among end users who used the app for 6 months. The end users were individuals with a confirmed diagnosis of CHD from 2 university-affiliated hospitals in Beijing, China.

Results
iCARE consists of a patient app, a care provider app, and a cloud platform. It has a set of algorithms that trigger tailored feedback and can send individualized interventions based on data from initial assessment and health monitoring via manual entry or wearable devices. For stage I usability testing, 88 hospitalized patients (72% [63/88] male; mean age 60 [SD 9.9] years) with CHD were included in the study. The mean score of the usability testing was 90.1 (interquartile range 83.3-99.0). Among enrolled participants, 90% (79/88) were satisfied with iCARE; 94% (83/88) and 82% (72/88) reported that iCARE was useful and easy to use, respectively. For stage II usability testing, 61 individuals with CHD (85% [52/61] male; mean age 53 [SD 8.2] years) who were from an intervention arm and used iCARE for at least six months were included. The mean total score on usability testing based on the questionnaire was 89.0 (interquartile distance: 77.0-99.5). Among enrolled participants, 89% (54/61) were satisfied with the use of iCARE, 93% (57/61) perceived it as useful, and 70% (43/61) as easy to use.

Conclusions
This study developed an intelligent, individualized, evidence-based, and theory-driven app (iCARE) to improve patients’ adherence to health behaviors and medication management. iCARE was identified to be highly acceptable, useful, and easy to use among individuals with a diagnosis of CHD.

Trial Registration
Chinese Clinical Trial Registry ChiCTR-INR-16010242; https://tinyurl.com/2p8bkrew
Effects of Person-Centered Care Using a Digital Platform and Structured Telephone Support for People With Chronic Obstructive Pulmonary Disease and Chronic Heart Failure: Randomized Controlled Trial
Authors: Ali Lilas , Wallström Sara , Fors Andreas , Barenfeld Emmelie , Fredholm Eva , Fu Michael , Goudarzi Mahboubeh , Gyllensten Hanna , Lindström Kjellberg Irma , Swedberg Karl , Vanfleteren Lowie E G W , Ekman Inger 
Published: December 2021

Background
Chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) are characterized by severe symptom burden and common acute worsening episodes that often require hospitalization and affect prognosis. Although many studies have shown that person-centered care (PCC) increases self-efficacy in patients with chronic conditions, studies on patients with COPD and CHF treated in primary care and the effects of PCC on the risk of hospitalization in these patients are scarce.

Objective
The aim of this study is to evaluate the effects of PCC through a combined digital platform and telephone support for people with COPD and CHF.

Methods
A multicenter randomized trial was conducted from 2018 to 2020. A total of 222 patients were recruited from 9 primary care centers. Patients diagnosed with COPD, CHF, or both and with internet access were eligible. Participants were randomized into either usual care (112/222, 50.5%) or PCC combined with usual care (110/222, 49.5%). The intervention’s main component was a personal health plan cocreated by the participants and assigned health care professionals. The health care professionals called the participants in the intervention group and encouraged narration to establish a partnership using PCC communication skills. A digital platform was used as a communication tool. The primary end point, divided into 2 categories (improved and deteriorated or unchanged), was a composite score of change in general self-efficacy and hospitalization or death 6 months after randomization. Data from the intention-to-treat group at 3- and 6-month follow-ups were analyzed. In addition, a per-protocol analysis was conducted on the participants who used the intervention.

Results
No significant differences were found in composite scores between the groups at the 3- and 6-month follow-ups. However, the per-protocol analysis of the 3-month follow-up revealed a significant difference in composite scores between the study groups (P=.047), although it was not maintained until the end of the 6-month follow-up (P=.24). This effect was driven by a change in general self-efficacy from baseline.

Conclusions
PCC using a combined digital platform and structured telephone support seems to be an option to increase the short-term self-efficacy of people with COPD and CHF. This study adds to the knowledge of conceptual innovations in primary care to support patients with COPD and CHF.

Trial Registration
ClinicalTrials.gov NCT03183817; http://clinicaltrials.gov/ct2/show/NCT03183817
Digital Prompts to Increase Engagement With the Headspace App and for Stress Regulation Among Parents: Feasibility Study
Authors: Militello Lisa , Sobolev Michael , Okeke Fabian , Adler Daniel A , Nahum-Shani Inbal 
Published: December 2021

Background
Given the interrelated health of children and parents, strategies to promote stress regulation are critically important in the family context. However, the uptake of preventive mental health is limited among parents owing to competing family demands.

Objective
In this study, we aim to determine whether it is feasible and acceptable to randomize digital prompts designed to engage parents in real-time brief mindfulness activities guided by a commercially available app.

Methods
We conducted a 30-day pilot microrandomized trial among a sample of parents who used Android smartphones. Each day during a parent-specified time frame, participants had a 50% probability of receiving a prompt with a message encouraging them to engage in a mindfulness activity using a commercial app, Headspace. In the 24 hours following randomization, ecological momentary assessments and passively collected smartphone data were used to assess proximal engagement (yes or no) with the app and any mindfulness activity (with or without the app). These data were combined with baseline and exit surveys to determine feasibility and acceptability.

Results
Over 4 months, 83 interested parents were screened, 48 were eligible, 16 were enrolled, and 10 were successfully onboarded. Reasons for nonparticipation included technology barriers, privacy concerns, time constraints, or change of mind. In total, 80% (8/10) of parents who onboarded successfully completed all aspects of the intervention. While it is feasible to randomize prompt delivery, only 60% (6/10) of parents reported that the timing of prompts was helpful despite having control over the delivery window. Across the study period, we observed higher self-reported engagement with Headspace on days with prompts (31/62, 50% of days), as opposed to days without prompts (33/103, 32% of days). This pattern was consistent for most participants in this study (7/8, 87%). The time spent using the app on days with prompts (mean 566, SD 378 seconds) was descriptively higher than on days without prompts (mean 225, SD 276 seconds). App usage was highest during the first week and declined over each of the remaining 3 weeks. However, self-reported engagement in mindfulness activities without the app increased over time. Self-reported engagement with any mindfulness activity was similar on days with (40/62, 65% of days) and without (65/103, 63% of days) prompts. Participants found the Headspace app helpful (10/10, 100%) and would recommend the program to others (9/10, 90%).

Conclusions
Preliminary findings suggest that parents are receptive to using mindfulness apps to support stress management, and prompts are likely to increase engagement with the app. However, we identified several implementation challenges in the current trial, specifically a need to optimize prompt timing and frequency as a strategy to engage users in preventive digital mental health.
Artificial Intelligence Education Programs for Health Care Professionals: Scoping Review
Authors: Charow Rebecca , Jeyakumar Tharshini , Younus Sarah , Dolatabadi Elham , Salhia Mohammad , Al-Mouaswas Dalia , Anderson Melanie , Balakumar Sarmini , Clare Megan , Dhalla Azra , Gillan Caitlin , Haghzare Shabnam , Jackson Ethan , Lalani Nadim , Mattson Jane , Peteanu Wanda , Tripp Tim , Waldorf Jacqueline , Williams Spencer , Tavares Walter , Wiljer David 
Published: December 2021

Background
As the adoption of artificial intelligence (AI) in health care increases, it will become increasingly crucial to involve health care professionals (HCPs) in developing, validating, and implementing AI-enabled technologies. However, because of a lack of AI literacy, most HCPs are not adequately prepared for this revolution. This is a significant barrier to adopting and implementing AI that will affect patients. In addition, the limited existing AI education programs face barriers to development and implementation at various levels of medical education.

Objective
With a view to informing future AI education programs for HCPs, this scoping review aims to provide an overview of the types of current or past AI education programs that pertains to the programs’ curricular content, modes of delivery, critical implementation factors for education delivery, and outcomes used to assess the programs’ effectiveness.

Methods
After the creation of a search strategy and keyword searches, a 2-stage screening process was conducted by 2 independent reviewers to determine study eligibility. When consensus was not reached, the conflict was resolved by consulting a third reviewer. This process consisted of a title and abstract scan and a full-text review. The articles were included if they discussed an actual training program or educational intervention, or a potential training program or educational intervention and the desired content to be covered, focused on AI, and were designed or intended for HCPs (at any stage of their career).

Results
Of the 10,094 unique citations scanned, 41 (0.41%) studies relevant to our eligibility criteria were identified. Among the 41 included studies, 10 (24%) described 13 unique programs and 31 (76%) discussed recommended curricular content. The curricular content of the unique programs ranged from AI use, AI interpretation, and cultivating skills to explain results derived from AI algorithms. The curricular topics were categorized into three main domains: cognitive, psychomotor, and affective.

Conclusions
This review provides an overview of the current landscape of AI in medical education and highlights the skills and competencies required by HCPs to effectively use AI in enhancing the quality of care and optimizing patient outcomes. Future education efforts should focus on the development of regulatory strategies, a multidisciplinary approach to curriculum redesign, a competency-based curriculum, and patient-clinician interaction.
The Effects of Intravenous Iron Infusion on Preoperative Hemoglobin Concentration in Iron Deficiency Anemia: Retrospective Observational Study
Authors: Nicholls Guy , Mehta Rajan , McVeagh Karen , Egan Matthew 
Published: December 2021

Background
An iron infusion pathway using Ferrinject (ferric carboxymaltose) was implemented at Southend University Hospital for preoperative surgical patients with iron deficiency anemia undergoing major surgery. This was based on a treatment algorithm proposed by Munting and colleagues according to the international consensus statement on perioperative management of anemia and the UK National Institute for Health and Care Excellence (NICE) guidelines. These guidelines state that intravenous iron is indicated when oral iron is poorly tolerated or ineffective, there is insufficient time to surgery, or due to a functional iron deficiency.

Objective
The objective of this study was to evaluate the change in adult hemoglobin (Hb) concentration (g/L) after Ferrinject infusion at the time of surgery.

Methods
Data were retrospectively collected on all surgical patients that received an iron infusion preoperatively for iron deficiency anemia from July 2019 to April 2020. Nonsurgical, obstetric, and pediatric patients, and those without a postinfusion Hb level measurement were excluded. Data collected included the Hb, ferritin, and transferrin levels pre and postinfusion; correct dose of intravenous iron received; and any adverse reactions noted.

Results
Thirty-two surgical patients with iron deficiency anemia received intravenous iron between July 2019 and April 2020 prior to surgery. The average pre and post iron infusion Hb concentration across the cohort was 97 g/L and 114 g/L, respectively (18% increase; P=.001). Two (6%) patients had a posttransfusion Hb level ≥130 g/L prior to surgery after infusion. Nine patients had both a pre and postinfusion ferritin level recorded, which showed an increase from 12 ng/mL preinfusion to 94 ng/mL postinfusion (P=.02). Twenty-three (72%) patients did not receive the full dose of intravenous iron based on their Hb level and weight. Twenty-four (75%) patients received an iron infusion >2 weeks prior to surgery and the other 8 (25%) patients received the infusion <2 weeks before their surgery. There was an average increase in Hb of 22% (21 g/L, 95% CI 13-28) and 5% (5 g/L, 95% CI 1-10), respectively, across the two groups (P=.03). There were no documented adverse reactions to intravenous iron.

Conclusions
Intravenous iron is an effective intervention to improve the Hb concentration in patients with iron deficiency anemia despite the majority of patients not receiving the full dose based on their baseline Hb level and weight. Increasing the interval time between infusion and surgery was associated with a greater increase in Hb, with only a minimal increase observed if given less than 2 weeks prior to surgery.
The Clinical Utility of a Handheld Elastic Scattering Spectroscopy Tool and Machine Learning in the Diagnosis and Referral Management of Skin Cancer by Primary Care Physicians
Authors: Tepedino Kelly , Thames Todd 
Published: December 2021

Background
Elastic scattering spectroscopy (ESS) is a noninvasive optical biopsy technique that can distinguish between normal and abnormal tissue in vivo. The handheld device measures ESS spectra of skin lesions and classifies lesions with an output of “Investigate Further” or “Monitor.” The algorithm was trained and validated with over 11,000 spectral scans from over 3500 skin lesions. The device performance was also evaluated in an associated clinical study.

Objective
The aim of this paper was to establish whether the use of a handheld ESS tool can improve the detection of skin malignancies by evaluating clinical performance while emulating a real-world telemedicine clinical care setting.

Methods
The associated clinical study examined an independent test set of 332 lesions in a prospective multicenter study that compared algorithm performance to biopsy results for diagnosing malignant lesions. A total of 50 cases were randomly selected from the study data base (25 malignant and 25 benign lesions). Device performance on these lesions had a 96% sensitivity. High-resolution digital images and the patient’s clinical information including prior skin cancer history, risk factors, and physical examination results were available for evaluation. A total of 57 primary care physicians participated in this study in 2 phases, the first phase with their standard-of-care diagnostic and the second phase regarding their evaluation with the device output. The physicians were educated on the ESS device before evaluating the cases in a random order. Case evaluation included the physician reporting their diagnosis, management decision, and confidence level without the device output in the first phase and with the device output in the second phase. The results were evaluated for sensitivity and specificity with confidence intervals.

Results
The diagnostic sensitivity of the readers without and with the use of the handheld ESS device increased significantly from 67% to 88% (P<.001). There was no significant difference in specificity at 40% and 53% (P=.05). The management sensitivity of the readers increased significantly with and without the use of the device, which, respectively, was 94% (91%-96%) and 81% (77%-85%) (P<.001), suggesting that the use of the device may reduce false negatives by 68%. Specificity was comparable for management decisions (P=.36) at 31% compared to 36% without the device.

Conclusions
The use of the handheld ESS device significantly improved diagnostic and management sensitivity over standard-of-care, with comparable specificity. While telemedicine has shown promise in many fields, studies have shown that in-person skin evaluation is superior to telemedicine evaluations; however, integration with this type of tool has the potential to improve early detection.
Pengaruh Kecerdasan Emosional Terhadap Hasil Belajar Biologi Peserta Didik
Authors: Utami Sartika Ayu , Damayanti Eka , Ismail Wahyuni 
Published: December 2021

Penelitian ini bertujuan untuk mengetahui pengaruh kecerdasan emosional terhadap hasil belajar biologi pada peserta didik. Jenis penelitian ini adalah penelitian ex post facto dengan populasi seluruh peserta didik kelas XII SMAN 1 Pangkep yang berjumlah 144 orang dan sampelnya 72 orang yang diambil dengan menggunakan systematic random sampling. Instrumen penelitian yang digunakan berupa angket kecerdasan emosional dan dokumentasi hasil belajar biologi peserta didik. Data tersebut kemudian dianalisis dengan menggunakan analisis deskriptif dan analisis regresi linear sederhana. Hasil penelitian menunjukkan thitung > ttabel dan nilai sig.= 0,000 < 0,05. Hal itu membuktikan bahwa kecerdasan emosional berpengaruh secara signifikan terhadap hasil belajar peserta didik XII SMA Negeri 1 Pangkep dengan sumbangan pengaruh sebesar 39,4 persen dan 60,6 persen yang dipengaruhi oleh variabel lain yang tidak diterliti dalam penelitian ini.
ANALISIS ADVERSITY QUOTIENT PADA PENYINTAS LEUKEMIA ANAK DALAM MENEMPUH PENDIDIKAN FORMAL
Authors: Setiadi Iwan 
Published: December 2021

Pendidikan adalah hak semua manusia. Penyintas Leukemia Anak (PLA) tidak banyak yang dapat melanjutkan pendidikan formal di sekolah karena keterbatasan yang dimilikinya terutama fisik. Penelitian ini menggunakan pendekatan kualitatif dengan jenis penelitian studi kasus, bertujuan untuk mengetahui bagaimana seorang PLA dapat mengikuti pendidikan formal di sekolah. Metode pengumpulan data menggunakan wawancara mendalam dan observasi. Teknik analisis data menggunakan konsep Miles & Huberman dan Hermeneutical Analisis. Hasil penelitian menggambarkan bahwa: 1) Tipe kecerdasan Adversity Quotient (AQ) yang diperlukan oleh PLA untuk menempuh pendidikan formal di sekolah adalah tipe Climber, 2) Perlu dukungan proaktif dari sekolah dengan “memaklumi” kondisi PLA, 3) Orang tua tetap harus memperhatikan dan menjaga kesehatan PLA agar tidak relaps dikemudian hari. Dengan demikian perlu adanya perhatian khusus baik dari orang tua maupun pihak sekolah agar seorang PLA tetap dapat melanjutkan pendidikan.
Factores perinatales asociados a macrosomía fetal, en un hospital de Quito-Ecuador
Authors: TOAPANTA-PINTA PAOLA , Vasco-Morales Santiago , Vasco-Toapanta Cristhian , Andrade Paola Alarcon , Guerra Andrés Merizalde 
Published: December 2021

Determinar las condiciones perinatales relacionadas con macrosomía
fetal, en nuestra población.

MÉTODOS:
Estudio transversal de los registros del programa publicado por
El Centro Latinoamericano de Perinatología, Salud de la Mujer y
Reproductiva, archivados en el Hospital Gineco-Obstétrico Isidro Ayora,
desde enero del 2008 hasta diciembre del 2016. Para las variables
numéricas se aplicó la prueba t. Las variables cualitativas se
analizaron con la prueba Chi cuadrado. Para el análisis
multivariado se utilizó modelos de regresión. En los resultados se
incluye el Odds Ratio crudo y ajustado con el intervalo
de confianza al 95%. Los datos fueron analizados con el paquete
estadístico R versión. 3.3.1 para Mac.

RESULTADOS:
Se encontró 1171(5.2%) neonatos macrosómicos. Las variables asociadas
a macrosomía fueron diabetes, edad gestacional, edad materna, gestas
previas, estado civil, sexo masculino, nacimiento vía cesárea,
además existe asociación negativa con embarazo múltiple.

CONCLUSIONES:
La macrosomía neonatal está relacionada con trastornos metabólicos en la
madre, la mayor edad gestacional y materna, acompañamiento de la
pareja durante el embarazo, la multiparidad, el
producto masculino. El resto de los factores sociales, étnicos,
las enfermedades crónicas y los trastornos propios del embarazo no
mostraron asociación con macrosomía fetal.