bluuebunny/crossref_metadata_2025_split huggingface dataset:
Improvisational Theater Games for Children in Park Interpretation
Authors: Macklin E. Kim , Hvenegaard Glen T. , Johnson Paul E. 
Published: September 2020

With children increasingly disconnected from nature and much interpretation geared toward adults, agencies need age-appropriate techniques for children. Improvisational theater games use group-based role-playing to solve problems through dialogue and activity in a creative, spontaneous, supportive, and interactive atmosphere. This paper highlights children's enjoyment and perceived learning resulting from a new improvisation program in Banff National Park, Canada. We thematically analyzed open-ended evaluations of an improvisation-dominated program. The activities enjoyed most included improvisation, because they involved fun, physical activity, creativity, challenge, and novelty. The least-enjoyed activities were physical activity games and an interpretive talk. Perceived learning was highest from an interpretive talk and nature walk and least from games focused on physical or group activities. Most perceived and desired learning related to natural history and park management topics. Despite being nontraditional and non-thematic, improvisation can contribute to children's enjoyment and perceived learning in park interpretive programs.
Determinants of venous catheter hemodialysis onset and subsequent switch to arteriovenous fistula: An epidemiological study in Lazio region
Authors: Tazza Luigi , Angelici Laura , Marino Claudia , Di Napoli Anteo , Bossola Maurizio , De Cicco Carmine , Davoli Marina , Agabiti Nera 
Published: September 2020

Background: The factors associated with the inability to start hemodialysis with an arteriovenous fistula (AVF) in chronic kidney disease patients are not fully understood. Aim: Evaluating factors associated with type of vascular access at the first chronic hemodialysis and at 1 year after it. Methods: The study cohort includes patients registered in the Regional Dialysis and Transplant Registry of Lazio undergoing first hemodialysis between 2008 and 2015. Logistic regression models were used to evaluate the association between socio-demographic, clinical and care/organizational factors, and vascular access at first hemodialysis. Cox regression models were used to assess the odds of switching to AVF during the first year of hemodialysis among patients starting dialysis with central venous catheter (CVC). Results: In the cohort of 6208 incident hemodialysis patients, 52.7% had an AVF and 47.3% had a CVC. Among the 2939 incident patients with CVC, 27.4% switched to FAV after 1 year. A higher probability of starting dialysis with AVF was observed among males (OR = 1.83; 95% CI 1.63–2.06), while a lower probability was observed among patients aged >85 years (OR 0.64; IC 95% 0.51–0.80). Patients with early referral to a nephrologist had a triple probability of start dialysis with AVF. We observed a higher odds of switch to AVF among males (HR = 1.62; 95% CI 1.40–1.89) and a lower odds among patients over 65 years. Conclusion: The observed high rate of AVF at the start of hemodialysis and of the switch from CVC to AVF in the first year, although declining since 2008, is a positive outcome. However, over one-third of patients maintain the CVC as vascular access for the first year because of unmodifiable factors, such as gender, age, comorbidity. The present study suggests that logistics/management and assistance/welfare problems may contribute to the delay or lack of AVF placement in incident hemodialysis patients or within the first year of dialysis.
An exploratory factor analysis of core competencies of public health professionals at primary care service level in Northeastern Thailand
Authors: Leethongdissakul Songkramchai , Chada Wilawun , Pengpid Supa , Chualinfa Sangud 
Published: September 2020

Background: Public health professionals play a significant role in primary care services in Thailand. Although efforts are being taken to establish professional standards it has neither been outlined nor been officially announced. There is a lack of understanding of what is a suitable set of core competencies for a public health professional. Objectives: This study aimed to explore the core competencies of public health professionals at the primary care service level in Thailand. Methods: A quantitative survey using a questionnaire was conducted in 862 public health professionals in the northeast of Thailand. Exploratory factor analysis was applied to develop a tool to test the competencies of public health professionals. Results: The results revealed core competencies in the following five main proficiencies: (1) public health administration and laws; (2) disease prevention and control; (3) social and environmental determinant of health and health research; (4) health promotion and community; and (5) basic medical care, screening, and diagnosis. In addition, the five core competencies included 50 items suitable for this sample. These factors accounted for 71.90% of the variance. Conclusion: In conclusion, this study’s finding provides significant recommendations to policymakers to improve and initiate a new policy or a standard guideline for public health education and human resource for health production and management in Thailand.
Proximal humeral fracture morphology in patients with advanced osteoarthritis: An observational study in a surgically treated cohort
Authors: Schmalzl Jonas , Jessen Malik , Gilbert Fabian , Gerhardt Christian , Lehmann Lars-Johannes 
Published: September 2020

Background: Several factors affect proximal humeral fracture (PHF) morphology. In the presence of glenohumeral osteoarthritis (GOA), the joint kinematics is alternated which might influence fracture configuration. The purpose of this study was to identify fracture patterns in patients with advanced osteoarthritis to facilitate recognition and treatment. Methods: In this retrospective analysis, and computed tomography (CT) scans of all patients undergoing surgical treatment for a PHF during a 5-year period were analyzed. Fracture pattern according to the AO Foundation/Orthopaedic Trauma Association (AO-OTA) classification and the presence of GOA were evaluated. In addition, critical shoulder angle (CSA), glenoid configuration, and glenoid inclination (GI) were measured. Results: Of the 713 patients, 574 met the inclusion criteria. A total of 166 patients showed radiological signs of GOA (28.9%). Advanced GOA (stage 2 or 3) was identified in 23 patients (4.0%). In this group, the mean age was 77 ± 10 years, mean CSA was 28.8 ± 4.2°, and the mean GI was 19.0 ± 7.8°. All fractures were extra-articular metaphyseal fractures (5 A2, 11 A3, 7 B1.1). Patients with advanced GOA had more than threefold risk (risk ratio 3.2; confidence interval 95% 2.80–3.74; p < 0.0001) for sustaining a metaphyseal fracture. In patients with GOA grade 1 compared to patients with no radiographic signs of GOA, this could not be observed. Conclusion: Patients experiencing PHF with radiological signs of advanced GOA have a higher risk of sustaining a metaphyseal fracture compared to individuals with the absence of or mild GOA. To date, no classification system for PHFs takes preexisting osteoarthritis into account, although it might indicate a different treatment and therefore the recognition is crucial.
A retrospective comparison of the effect of eMP CS and traditional PS prosthesis on ERAS of total knee arthroplasty
Authors: Ye Yun , Liu Jiong , Tian Zhiyong , Chen Hongqiang , Dai Kejin , Nie Hongling , Zhou Xiang 
Published: September 2020

Introduction: The theoretical advantage of medial pivot (MP) knee was thought to justify and replicate the natural knee motion, however, rarely have the comparisons between different designed prosthesis on the enhanced recovery after surgery (ERAS) of TKA can be available. We compared the effect of using Evolution Medial Pivot(eMP) knee system cruciate-substituting (CS) prosthesis and traditional posterior-stabilized(PS) prosthesis on the enhanced recovery after surgery (ERAS) of TKA in order to have a profound understanding of the clinical effects of medial pivot prosthesis. Hypotheses: eMP-CS prostheses can help patients to achieve better recovery after TKA Methods: This study was a retrospective comparison between 2 groups of patients having unilateral TKA(48MP-CS-TKA vs 52 PS-TKA) from Jan 2019 to Mar 2020. The main factors were compared in 2 groups, including Visual Analogue Scale(VAS) pain score,HSS score,FJS-12,range of motion(ROM) and incidence of perioperative complications,as well as overall satisfaction. Results: The VAS score was significantly lower at 1 week,6weeks,3 months and 6 months postoperation than preoperation in two groups(P＜0.05).The HSS score was significant higher at 1 week,,6weeks,3 months and 6 months postoperation than preoperation in two groups (P＜0. 05).The range of motion of knee joint was more than 90° at 1 week after operation in both groups. The recovery of ROM was satisfactory at the early stage,and the ROM increased further with time.There was no statistical difference in VAS,HSS and ROM between two groups in 1 week,6 weeks,3 months and 6 months postoperatively(P＞0.05).In the last follow-up,“Climbing stairs” and “Standing from low sitting position” were the very condition in which the eMP group scored higer.None statistical difference in FJS-12 total score was found between two groups. No significant difference in perioperative complication incidence and blood transfusion rate,and patient-reported satisfaction were observed between two groups(P＞0. 05). Conclusion: Both eMP-CS prostheses and traditional PS prostheses can help to achieve ERAS after TKA.All patients get a satisfying knee function,and the incidence of perioperative complications was low. Nevertheless,it is more natural for eMP-CS prostheses patients to walk stairs and stand up,but no significant difference in patient-reported satisfaction was observed between eMP-CS prostheses and tradional PS prostheses.
Temperature Dependence of G and D’ Phonons in Monolayer to Few-Layer Graphene with Vacancies
Authors: Yang Mingming , Wang Longlong , Qiao Xiaofen , Liu Yi , Liu Yufan , Shi Yafang , Wu Hongli , Liang Baolai , Li Xiaoli , Zhao Xiaohui 
Published: September 2020

AbstractThe defects into the hexagonal network of a sp2-hybridized carbon atom have been demonstrated to have a significant influence on intrinsic properties of graphene systems. In this paper, we presented a study of temperature-dependent Raman spectra of G peak and D’ band at low temperatures from 78 to 318 K in defective monolayer to few-layer graphene induced by ion C+ bombardment under the determination of vacancy uniformity. Defects lead to the increase of the negative temperature coefficient of G peak, with a value almost identical to that of D’ band. However, the variation of frequency and linewidth of G peak with layer number is contrary to D’ band. It derives from the related electron-phonon interaction in G and D’ phonon in the disorder-induced Raman scattering process. Our results are helpful to understand the mechanism of temperature-dependent phonons in graphene-based materials and provide valuable information on thermal properties of defects for the application of graphene-based devices.
Robust edge-based biomarker discovery improves prediction of breast cancer metastasis
Authors: Adnan Nahim , Lei Chengwei , Ruan Jianhua 
Published: September 2020

AbstractBackgroundThe abundance of molecular profiling of breast cancer tissues entailed active research on molecular marker-based early diagnosis of metastasis. Recently there is a surging interest in combining gene expression with gene networks such as protein-protein interaction (PPI) network, gene co-expression (CE) network and pathway information to identify robust and accurate biomarkers for metastasis prediction, reflecting the common belief that cancer is a systems biology disease. However, controversy exists in the literature regarding whether network markers are indeed better features than genes alone for predicting as well as understanding metastasis. We believe much of the existing results may have been biased by the overly complicated prediction algorithms, unfair evaluation, and lack of rigorous statistics. In this study, we propose a simple approach to use network edges as features, based on two types of networks respectively, and compared their prediction power using three classification algorithms and rigorous statistical procedure on one of the largest datasets available. To detect biomarkers that are significant for the prediction and to compare the robustness of different feature types, we propose an unbiased and novel procedure to measure feature importance that eliminates the potential bias from factors such as different sample size, number of features, as well as class distribution.ResultsExperimental results reveal that edge-based feature types consistently outperformed gene-based feature type in random forest and logistic regression models under all performance evaluation metrics, while the prediction accuracy of edge-based support vector machine (SVM) model was poorer, due to the larger number of edge features compared to gene features and the lack of feature selection in SVM model. Experimental results also show that edge features are much more robust than gene features and the top biomarkers from edge feature types are statistically more significantly enriched in the biological processes that are well known to be related to breast cancer metastasis.ConclusionsOverall, this study validates the utility of edge features as biomarkers but also highlights the importance of carefully designed experimental procedures in order to achieve statistically reliable comparison results.
Genome-wide identification and characterization of ABA receptor PYL gene family in rice
Authors: Yadav Shashank Kumar , Santosh Kumar Vinjamuri Venkata , Verma Rakesh Kumar , Yadav Pragya , Saroha Ankit , Wankhede Dhammaprakash Pandhari , Chaudhary Bhupendra , Chinnusamy Viswanathan 
Published: September 2020

AbstractBackgroundAbscisic acid (ABA), a key phytohormone that controls plant growth and stress responses, is sensed by the pyrabactin resistance 1(PYR1)/PYR1-like (PYL)/regulatory components of the ABA receptor (RCAR) family of proteins. Comprehensive information on evolution and function ofPYLgene family in rice (Oryza sativa) needs further investigation. This study made detailed analysis on evolutionary relationship between PYL family members, collinearity, synteny, gene structure, protein motifs,cis-regulatory elements (CREs), SNP variations, miRNAs targetingPYLsand expression profiles in different tissues and stress responses.ResultsBased on sequence homology withArabidopsisPYL proteins, we identified a total of 13 PYLs in rice (BOP clade) and maize (PACCMAD clade), while other members of BOP (wheat – each diploid genome, barley andBrachypodium) and PACCMAD (sorghum and foxtail millet) have 8-9 PYLs. The phylogenetic analysis divided PYLs into three subfamilies that are structurally and functionally conserved across species. Gene structure and motif analysis ofOsPYLs revealed that members of each subfamily have similar gene and motif structure. Segmental duplication appears be the driving force for the expansion ofPYLs, and the majority of thePYLsunderwent evolution under purifying selection in rice. 32 unique potential miRNAs that might targetPYLswere identified in rice. Thus, the predicted regulation ofPYLsthrough miRNAs in rice is more elaborate as compared withB. napus. Further, the miRNAs identified to in this study were also regulated by stresses, which adds additional layer of regulation ofPYLs. The frequency of SAPs identified was higher inindicacultivars and were predominantly located in START domain that participate in ABA binding. The promoters of most of theOsPYLs havecis-regulatory elements involved in imparting abiotic stress responsive expression. In silico and q-RT-PCR expression analyses ofPYLgenes revealed multifaceted role of ABARs in shaping plant development as well as abiotic stress responses.ConclusionThe predicted miRNA mediated regulation ofOsPYLsand stress regulated expression of allOsPYLs, at least, under one stress, lays foundation for further validation and fine tuning ABA receptors for stress tolerance without yield penalty in rice.
The burden of low back pain in Brazil: estimates from the Global Burden of Disease 2017 Study
Authors: de David Caroline Nespolo , Deligne Lucas de Melo Castro , da Silva Rodolfo Souza , Malta Deborah Carvalho , Duncan Bruce B. , Passos Valéria Maria de Azeredo , Cousin Ewerton 
Published: September 2020

Abstract
Background
The prevalence and burden of musculoskeletal (MSK) conditions are growing around the world, and low back pain (LBP) is the most significant of the five defined MSK disorders in the Global Burden of Disease (GBD) study. LBP has been the leading cause of non-fatal health loss for the last three decades. The objective of this study is to describe the current status and trends of the burden due to LBP in Brazil based on information drawn from the GBD 2017 study.

Methods
We estimated prevalence and years lived with disability (YLDs) for LBP by Brazilian federative units, sex, age group, and age-standardized between 1990 and 2017 and conducted a decomposition analysis of changes in age- and sex-specific YLD rates attributable to total population growth and population ageing for the purpose of understanding the drivers of changes in LBP YLDs rates in Brazil. Furthermore, we analyzed the changes in disability-adjusted life years (DALYs) rankings for this disease over the period.

Results
The results show high prevalence and burden of LBP in Brazil. LBP prevalence increased 26.83% (95% UI 23.08 to 30.41) from 1990 to 2017. This MSK condition represents the most important cause of YLDs in Brazil, where the increase in burden is mainly related to increase in population size and ageing. The LBP age-standardized YLDs rate are similar among Brazilian federative units. LBP ranks in the top three causes of DALYs in Brazil, even though it does not contribute to mortality.

Conclusions
Findings from this study show LBP to be the most important cause of YLDs and the 3rd leading cause of DALYs in Brazil. The Brazilian population is ageing, and the country has been experiencing a rapid epidemiological transition, which generates an increasing number of people who need chronic care. In this scenario, more attention should be paid to the burden of non-fatal health conditions.
Inequalities in the burden of female breast cancer in Brazil, 1990–2017
Authors: Guerra Maximiliano Ribeiro , Nogueira Mário Círio , Malta Deborah Carvalho , Côrrea Camila Soares Lima , de Souza Maria de Fatima Marinho , Curado Maria Paula , Felisbino-Mendes Mariana Santos , Mooney Meghan , Naghavi Mohsen , Bustamante-Teixeira Maria Teresa 
Published: September 2020

Abstract
Background
Breast cancer is the most frequently diagnosed cancer in women and the leading cause of cancer death among females worldwide. In recent decades, breast cancer death rates have been stable or decreasing in more developed regions; however, this has not been observed in less developed regions. This study aims to evaluate inequalities in the burden of female breast cancer in Brazil including an analysis of interregional and interstate patterns in incidence, mortality and disability-adjusted life years (DALYs) rates from 1990 to 2017, and mortality-to-incidence ratio (MIR), and their association with the Socio-demographic Index (SDI).

Methods
Using estimates from the global burden of disease (GBD) study, we applied a spatial exploratory analysis technique to obtain measurements of global and local spatial correlation. Percentage changes of breast cancer incidence, mortality, and DALYs rates between 1990 and 2017 were calculated, and maps were developed to show the spatial distribution of the variables. Spatial panel models were adjusted to investigate the association between rates and SDI in Brazilian states.

Results
In Brazil, while breast cancer mortality rate have had modest reduction (−4.45%; 95% UI: −6.97; −1.76) between 1990 and 2017, the incidence rate increased substantially (+39.99%; 95% UI: 34.90; 45.39). Breast cancer incidence and mortality rates in 1990 and 2017 were higher in regions with higher SDI, i.e., the most developed ones. While SDI increased in all Brazilian states between 1990 and 2017, notably in less developed regions, MIR decreased, more notably in more developed regions. The SDI had a positive association with incidence rate and a negative association with MIR.

Conclusion
Such findings suggest an improvement in breast cancer survival in the period, which may be related to a broader access to diagnostic methods and treatment. This study also revealed the inequality in breast cancer outcomes among Brazilian states and may guide public policy priorities for disease control in the country.
Changes in the quality of cause-of-death statistics in Brazil: garbage codes among registered deaths in 1996–2016
Authors: França Elisabeth , Ishitani Lenice Harumi , Teixeira Renato , Duncan Bruce B. , Marinho Fatima , Naghavi Mohsen 
Published: September 2020

Abstract
Background
Registered causes in vital statistics classified as garbage codes (GC) are considered indicators of quality of cause-of-death data. Our aim was to describe temporal changes in this quality in Brazil, and the leading GCs according to levels assembled for the Global Burden of Disease (GBD) study. We also assessed socioeconomic differences in the burden of different levels of GCs at a regional level.

Methods
We extracted data from the Brazilian Mortality Information System from 1996 to 2016. All three- and four-digit ICD-10 codes considered GC were selected and classified into four categories, according to the GBD study proposal. GC levels 1 and 2 are the most damaging unusable codes, or major GCs. Proportionate distribution of deaths by GC levels according selected variables were performed. Age-standardized mortality rates after correction of underreporting of deaths were calculated to investigate temporal relationships as was the linear association adjusted for completeness between GC rates in states and the Sociodemographic Index (SDI) from the GBD study, for 1996–2005 and 2006–2016. We classified Brazilian states into three classes of development by applying tertiles cutoffs in the SDI state-level estimates.

Results
Age-standardized mortality rates due to GCs in Brazil decreased from 1996 to 2016, particularly level 1 GCs. The most important GC groups were ill-defined causes (level 1) in 1996, and pneumonia unspecified (level 4) in 2016. At state level, there was a significant inverse association between SDI and the rate of level 1–2 GCs in 1996–2005, but both SDI and completeness had a non-expected significant direct association with levels 3–4. In 2006–2016, states with higher SDIs tended to have lower rates of all types of GCs. Mortality rates due to major GCs decreased in all three SDI classes in 1996–2016, but GC levels 3–4 decreased only in the high SDI category. States classified in the low or medium SDI groups were responsible for the most important decline of major GCs.

Conclusion
Occurrence of major GCs are associated with socioeconomic determinants over time in Brazil. Their reduction with decreasing disparity in rates between socioeconomic groups indicates progress in reducing inequalities and strengthening cause-of-death statistics in the country.