bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of gas spin and Lyman–Werner flux on black hole seed formation in cosmological simulations: implications for direct collapse
Authors: Bhowmick Aklant K , Blecha Laura , Torrey Paul , Kelley Luke Zoltan , Vogelsberger Mark , Nelson Dylan , Weinberger Rainer , Hernquist Lars 
Published: November 2021

ABSTRACT
Direct collapse black holes (BHs) are promising candidates for producing massive z ≳ 6 quasars, but their formation requires fine-tuned conditions. In this work, we use cosmological zoom simulations to study systematically the impact of requiring: (1) low gas angular momentum (spin), and (2) a minimum incident Lyman–Werner (LW) flux in order to form BH seeds. We probe the formation of seeds (with initial masses of $M_{\rm seed} \sim 10^4\!-\!10^6\, \mathrm{M}_{\odot }\, h^{-1})$ in haloes with a total mass &gt;3000 × Mseed and a dense, metal-poor gas mass &gt;5 × Mseed. Within this framework, we find that the seed-forming haloes have a prior history of star formation and metal enrichment, but they also contain pockets of dense, metal-poor gas. When seeding is further restricted to haloes with low gas spins, the number of seeds formed is suppressed by factors of ∼6 compared to the baseline model, regardless of the seed mass. Seed formation is much more strongly impacted if the dense, metal-poor gas is required to have a critical LW flux (Jcrit). Even for Jcrit values as low as 50J21, no $8\times 10^{5}~\mathrm{M}_{\odot }\, h^{-1}$ seeds are formed. While lower mass ($1.25\times 10^{4},1\times 10^{5}~\mathrm{M}_{\odot }\, h^{-1}$) seeds do form, they are strongly suppressed (by factors of ∼10–100) compared to the baseline model at gas mass resolutions of $\sim 10^4~\mathrm{M}_{\odot }\, h^{-1}$ (with even stronger suppression at higher resolutions). As a result, BH merger rates are also similarly suppressed. Since early BH growth is dominated by mergers in our models, none of the seeds are able to grow to the supermassive regime ($\gtrsim 10^6~\mathrm{M}_{\odot }\, h^{-1}$) by z = 7. Our results hint that producing the bulk of the z ≳ 6 supermassive BH population may require alternate seeding scenarios that do not depend on the LW flux, early BH growth dominated by rapid or super-Eddington accretion, or a combination of these possibilities.
Type I CRISPR-Cas provides robust immunity but incomplete attenuation of phage-induced cellular stress
Authors: Malone Lucia M , Hampton Hannah G , Morgan Xochitl C , Fineran Peter C 
Published: November 2021

AbstractDuring infection, phages manipulate bacteria to redirect metabolism towards viral proliferation. To counteract phages, some bacteria employ CRISPR-Cas systems that provide adaptive immunity. While CRISPR-Cas mechanisms have been studied extensively, their effects on both the phage and the host during phage infection remains poorly understood. Here, we analysed the infection of Serratia by a siphovirus (JS26) and the transcriptomic response with, or without type I-E or I-F CRISPR-Cas immunity. In non-immune Serratia, phage infection altered bacterial metabolism by upregulating anaerobic respiration and amino acid biosynthesis genes, while flagella production was suppressed. Furthermore, phage proliferation required a late-expressed viral Cas4 homologue, which did not influence CRISPR adaptation. While type I-E and I-F immunity provided robust defence against phage infection, phage development still impacted the bacterial host. Moreover, DNA repair and SOS response pathways were upregulated during type I immunity. We also discovered that the type I-F system is controlled by a positive autoregulatory feedback loop that is activated upon phage targeting during type I-F immunity, leading to a controlled anti-phage response. Overall, our results provide new insight into phage-host dynamics and the impact of CRISPR immunity within the infected cell.
An Analytic Framework for Interpreting Investment Regressions in the Presence of Financial Constraints
Authors: Abel Andrew B , Panageas Stavros 
Published: November 2021

Abstract
We derive analytic solutions for the valuation, optimal investment, and optimal payout of a financially constrained firm. While marginal $q$ and average $q$ would be identically equal in the absence of financial constraints, they differ when financial constraints bind. We use analytic solutions to characterize the properties of regressions of investment on average $q$ and cash flow. The coefficient on cash flow is positive, but does not isolate the impact of the financial constraint, since it also partially reflects the impact of persistent profitability. The coefficient on average $q$ understates the impact of persistent profitability.
Intragenerational Social Mobility and Well-being in Great Britain: A Biomarker Approach
Authors: Präg Patrick , Fritsch Nina-Sophie , Richards Lindsay 
Published: November 2021

AbstractSocial theory has long predicted that social mobility, in particular downward social mobility, is detrimental to the well-being of individuals. Dissociative and “falling from grace” theories suggest that mobility is stressful due to the weakening of social ties, feelings of alienation, and loss of status. In light of these theories, it is a puzzle that the majority of quantitative studies in this area have shown null results. Our approach to resolve the puzzle is two-fold. First, we argue for a broader conception of the mobility process than is often used and thus focus on intragenerational occupational class mobility rather than restricting ourselves to the more commonly studied intergenerational mobility. Second, we argue that self-reported measures may be biased by habituation (or “entrenched deprivation”). Using nurse-collected health and biomarker data from the UK Household Longitudinal Study (2010–2012, N = 4,123), we derive a measure of allostatic load as an objective gauge of physiological “wear and tear” and compare patterns of mobility effects with self-reports of health using diagonal reference models. Our findings indicate a strong class gradient in both allostatic load and self-rated health, and that both first and current job matter for current well-being outcomes. However, in terms of the effects of mobility itself, we find that intragenerational social mobility is consequential for allostatic load, but not for self-rated health. Downward mobility is detrimental and upward mobility beneficial for well-being as assessed by allostatic load. Thus, these findings do not support the idea of generalized stress from dissociation, but they do support the “falling from grace” hypothesis of negative downward mobility effects. Our findings have a further implication, namely that the differences in mobility effects between the objective and subjective outcome infer the presence of entrenched deprivation. Null results in studies of self-rated outcomes may therefore be a methodological artifact, rather than an outright rejection of decades-old social theory.
The Performance and Trajectory of Medical Students With Disabilities: Results From a Multisite, Multicohort Study
Authors: Meeks Lisa M. , Plegue Melissa , Swenor Bonnielin K. , Moreland Christopher J. , Jain Sharad , Grabowski Christina J. , Westervelt Marjorie , Case Ben , Eidtson William H. , Patwari Rahul , Angoff Nancy R. , LeConche Jack , Temple Bliss M. , Poullos Peter , Sanchez-Guzman Mijiza , Coates Caitlyn , Low Christine , Henderson Mark C. , Purkiss Joel , Kim Michael H. 
Published: November 2021

Purpose
To conduct a post–Americans with Disabilities Act Amendments Act of 2008 multisite, multicohort study called the Pathways Project to assess the performance and trajectory of medical students with disabilities (SWDs).

Method
From June to December 2020, the authors conducted a matched cohort study of SWDs and nondisabled controls from 2 graduating cohorts (2018 and 2019) across 11 U.S. MD-granting medical schools. Each SWD was matched with 2 controls, one from their institution and, whenever possible, one from their cohort for Medical College Admission Test score and self-reported gender. Outcome measures included final attempt Step 1 and Step 2 Clinical Knowledge scores, time to graduation, leave of absence, matching on first attempt, and matching to primary care.

Results
A total of 171 SWDs and 341 controls were included; the majority of SWDs had cognitive/learning disabilities (118/171, 69.0%). Compared with controls, SWDs with physical/sensory disabilities had similar times to graduation (88.6%, 95% confidence interval [CI]: 77.0, 100.0 vs 95.1%, 95% CI: 90.3, 99.8; P = .20), Step 1 scores (229.6 vs 233.4; P = .118), and match on first attempt (93.9%, 95% CI: 86.9, 100.0 vs 94.6%, 95% CI: 91.8, 97.4; P = .842), while SWDs with cognitive/learning disabilities had lower Step 1 scores (219.4; P < .001) and were less likely to graduate on time (81.2%, 95% CI: 69.2, 93.2; P = .003) and match on first attempt (85.3%, 95% CI: 78.0, 92.7; P = .009). Accommodated SWDs had Step 1 scores that were 5.9 points higher than nonaccommodated SWDs (95% CI: –0.7, 12.5; P = .08).

Conclusions
Structural barriers remain for SWDs with cognitive/learning disabilities, which could be partially mitigated by accommodations on high-stakes exams.
Indication of Proximal Gastrectomy for Advanced Proximal Gastric Cancer Based on Lymph Node Metastasis at the Distal Part of the Stomach
Authors: Lee Sejin , Son Won Jeong , Roh Yun Ho , Song Jeong Ho , Park Sung Hyun , Cho Minah , Kim Yoo Min , Hyung Woo Jin , Kim Hyoung-Il 
Published: November 2021

Objective:
To suggest the possible indication of proximal gastrectomy for advanced gastric cancer located at the upper third of the stomach.

Background:
Proximal gastrectomy has been an alternative surgical procedure for early proximal gastric cancer due to its benefits for quality of life while maintaining oncological outcomes. However, the oncological safety of proximal gastrectomy for advanced tumors remains unclear.

Methods:
We retrospectively reviewed data from 878 patients who underwent radical total gastrectomy from 2003 to 2018 for pathologic T2–T4 gastric cancer in the upper third of the stomach. We identified risk factors for lymph node metastasis at the distal part of the stomach, which was not dissected in proximal gastrectomy. Subsequently, we evaluated the metastasis rate and therapeutic value index of lymph nodes at the distal part of the stomach in patients with none of these risk factors.

Results:
Multivariable analysis revealed that esophagogastric junction (EGJ)-tumor epicenter distance >30 mm, tumor size >70 mm, macroscopic type IV tumor, and serosal invasion were risk factors for lymph node metastasis at the distal stomach. In patients without risk factors, the therapeutic value index for any lymph nodes at the distal stomach was 0.8, suggesting that lymph node dissection could be omitted in these patients.

Conclusions:
EGJ-tumor epicenter distance ≤ 30 mm, tumor size ≤ 70 mm, not a macroscopic type IV tumor, and no serosal invasion could be an indication of proximal gastrectomy for advanced gastric cancer located at the upper third of the stomach.
Improvement and International Validation of the Predictive Probability of the Patient Demographics, Radiographic Index, and Surgical Invasiveness for Mechanical Failure (PRISM) Model for Preventive Procedures in Adult Spinal Deformity Surgery
Authors: Yagi Mitsuru , Hosogane Naobumi , Ames Christopher P. , Smith Justin S. , Shaffrey Christopher I. , Schwab Frank J. , Lafage Virginie , Bess Shay , Suzuki Satoshi , Satoshi Nori , Takahashi Yohei , Tsuji Osahiko , Nagoshi Narihito , Nakamura Masaya , Matsumoto Morio , Watanabe Kota 
Published: November 2021

Study Design.
This is an international multicenter retrospective review of 219 surgically treated consecutive adult spinal deformity (ASD) patients who had a minimum of five fused segments, completed a 2-year follow-up.

Objective.
The purpose of this study was to add the indices of preventive procedures to improve and to validate the predictive probability of the PRISM (patient demographics, radiographic index, and surgical invasiveness for mechanical failure) for mechanical failure (MF) following ASD surgery.

Summary of Background Data.
The PRISM was developed from the data of 321 ASD patients, which stratified the risk of MF from six types of risk.

Methods.
Data from 136 Japanese ASD patients (age 49 ± 21 yr, 88% female) were used to develop PRISM2, and data from 83 US ASD patients (age 58 ± 12 yr, 86% female) were used for the external validation. We analyzed the associations between three preventive procedures (UIV+1 tethering [TH], teriparatide [TP], and multirod [MR]) and MF by multivariate logistic regression analysis (MRA). The values for the nearest integer of the β of the procedures were added to the six indices of the original PRISM to establish the PRISM2. The discriminative ability of the PRISM/ PRISM2 for MF was evaluated using the area under the receiver operating characteristic curve (AUC) and the precision-recall (PR) curve. The Cochran-Armitage test was used to analyze the trend between PRISM/PRISM2 scores and MF.

Results.
MF developed in 25% (34 cases). The β values for the preventive procedures calculated by MRA were TH: –2.5, TP: –3.0, and MR: –2.1. The Cochran-Armitage test showed an excellent trend between MF and PRISM/2. The diagnostic ability was superior for the PRISM2 compared with the PRISM (PRISM2; AUC = 0.94 [0.90–0.98], PRISM; AUC = 0.87 [0.81–0.93], difference = –0.07 [–0.11 to –0.03], P
< 0.01). The AUC of the PRISM2 was 0.70 [0.59–0.81, P < 0.01] in the US patient cohort.

Conclusion.
We refined the PRISM by adding preventive procedures to the risk indices. Further validation and adjustment in a large different patient cohorts may improve the predictive probability of PRISM2.

Level of Evidence: 3
Rare Case of Double-Positive CD4/CD8 Immunophenotype in Lennert Lymphoma With Cutaneous Involvement: A Case Report
Authors: Kim Joong Ho , Lee Soo Kyung , Kim Ho Young , Uh Ji An , Lee Jae Ho , Kim Myoung Shin , Lee Un Ha 
Published: November 2021

Abstract:
Lennert lymphoma is a lymphoepithelioid variant of peripheral T-cell lymphoma (not otherwise specified) with characteristics that do not fit into other peripheral T-cell lymphoma categories. Lennert lymphoma is primarily a nodal disease, and skin involvement may be exhibited. Cutaneous manifestations in Lennert lymphoma are nonspecific and include erythematous papules, nodules, and small plaques. Histological examination of cutaneous involvement characteristically presents epithelioid histiocytes and atypical small lymphocytes around vessels or appendages. A lymph node (LN) biopsy is essential for Lennert lymphoma diagnosis. In Lennert lymphoma, immunohistochemistry of both LNs and the involved skin reveals T-cell marker positivity. Although most Lennert lymphoma cases present with a single-positive CD4/CD8 immunophenotype, few cases present with a double-positive CD4/CD8 immunophenotype. We report a case of a 54-year-old woman presenting with fever, chills, general weakness, and a skin rash of erythematous patches on the trunk, extremities, and buttocks. A skin biopsy of the buttocks revealed atypical lymphocytes around the dermal vessels. In immunohistochemistry, these atypical lymphocytes stained positive for CD3, CD4, CD8, and CD68 but negative for CD20, CD30, and granzyme B. Similarly, a biopsy of the axillary LN revealed numerous epithelioid cells with atypical lymphocytes, exhibiting positivity for CD3, CD4, CD8, and CD68 but negativity for CD20, CD30, and S-100. Ki-67 was overexpressed in both the skin and LN. The final diagnosis of the patient was Lennert lymphoma with cutaneous involvement and a rare double-positive CD4/CD8 immunophenotype. The patient was transferred to another hospital for chemotherapy as per her request.
The Impact of Changes in Work Arrangements During COVID-19 Pandemic on the Lifestyle of Qatar's Working Population
Authors: Abed Alah Muna , Abdeen Sami , Kehyayan Vahe , Bougmiza Iheb 
Published: November 2021

Objectives:
To explore the impact of changing work arrangements during COVID-19 on diet, physical activity, body weight, and sleep of Qatar's working population.

Methods:
A web-based survey targeting working adults who were residing in Qatar during the period of home confinement was conducted.

Results:
About 47% of 1061 participants reported weight gain. Higher proportions of participants reported consuming more fatty foods (P = 0.007), more sugary foods (P = 0.001), and greater increase in screen and sitting/reclining times (P < 0.001) among the work from home (WFH) group. Participants with higher adverse dietary changes score were more likely to report weight gain in both the WFH (adjusted OR 1.38, 95% CI 1.28 to 1.49), and working regularly groups (adjusted OR, 1.31, 95% CI 1.20 to 1.43) with P < 0.001.

Conclusion:
Qatar's working population experienced adverse lifestyle changes which were more prominent among those who shifted to WFH.
Hardiness and Burnout in Adult U.S. Workers
Authors: Bartone Paul T. , McDonald Kelly , Hansma Braden J. 
Published: November 2021

Objective:
Burnout is a costly problem, and it appears to be getting worse due to COVID-related stressors. It is thus important for organizations to find better tools to prevent and mitigate worker burnout.

Methods:
Conditional PROCESS path analysis was used to assess the relation of hardiness to burnout in a representative sample of U.S. workers, with sex and age as potential moderators.

Results:
Hardiness is associated with reduced burnout symptoms. Sex did not moderate this relation. A moderating effect for age was observed, with more burnout appearing in younger, less hardy workers.

Conclusions:
Findings suggest hardiness operates similarly for men and women as a buffer against burnout, and that older workers are less vulnerable to burnout. Training programs to increase stress appraisals and coping skills used by more experienced, hardy workers may be beneficial in reducing burnout.
Utilizing Supplemental Online Modules for Physician Assistant Student Electrocardiogram Interpretation Training
Authors: Aycock Mallory M. , Brown Sheena D. 
Published: November 2021

Purpose
The literature suggests that graduating medical and physician assistant (PA) students lack competency in electrocardiogram (ECG) interpretation. This project aimed to determine whether use of perceptual adaptive learning modules (PALMs) would improve PA students' ECG interpretation, alter self-perceptions of their ECG education, or both.

Methods
PALMs were incorporated into the PA curriculum after lecture-based ECG learning. Students' pretest, posttest, and delayed-posttest scores were then compared. Students' ability to correctly interpret ECGs (accuracy) and the percentage of ECGs accurately interpreted within 15 seconds or less (fluency) also were evaluated. Finally, students' perceptions of PALMs and overall ECG training were assessed.

Results
PALM training improved ECG interpretation accuracy and fluency (p < .0001), as well as delayed-posttest accuracy and fluency (p < .0001). The majority of student respondents felt supplemental training enhanced their learning.

Conclusion
These perception results combined with data on ECG interpretation improvement supports continued use of supplemental PALMs in ECG interpretation training.
Clinical Evaluation of a Novel Laser-Ablated Titanium Implant System for Bone Anchored Hearing Systems in a Pediatric Population and the Relationship of Resonance Frequency Analysis With Implant Survival
Authors: Osborne Max Sallis , Child-Hymas Anne , Holmberg Marcus , Thomsen Peter , Johansson Martin L. , McDermott Ann-Louise 
Published: November 2021

Objective:
To evaluate the clinical outcomes of pediatric patients implanted a novel 4.5 mm wide laser ablated titanium bone anchored implant system and to evaluate the implant stability over the first 12-month period.

Study Design:
A prospective, single-subject, repeated measure, cohort study. Participants served as their own controls.

Setting:
Community and tertiary referral hospital pediatric assessment center.

Patients:
A total of 115 consecutive pediatric patients aged 4 to 15 years were implanted with 176 laser ablated titanium bone anchored implants from January 2016 to January 2019.

Main Outcome Measure:
Clinical outcomes, implant failure rates, and post implantation implant stability quotient (ISQ) scores were studied over the first 12-month period. Data were analyzed for statistical significance through mixed effect modeling, with the significance level p = 0.01.

Results:
A median 12-month survival of 96.6% was observed. Six implants (3.5%) were lost in total, one of these (0.6%) was lost due to trauma. Adverse skin reactions (Holgers grade 2–4) were observed in 4.4% of all postoperative visits, occurring in 22 individuals (19.1%). Neither the ISQ high (ISQH) nor ISQ low (ISQL) values increased significantly between the stage 1 and 2 surgeries. In contrast, the ISQ results, irrespective of abutment size, demonstrated an increasing trend from 49.1 to 57 over the 12 months review period. A statistically significant change was only demonstrated from the 3 months follow up onwards.

Conclusion:
The use of 4.5 mm wide laser-ablated titanium bone anchored hearing implants resulted in superior survival rates and excellent clinical outcomes compared with previous implant systems.
Experiences of Losing Bowel Control After Lower Anterior Resection With Sphincter Saving Surgery for Rectal Cancer
Authors: Tsui Ho , Huang Xuan-Yi 
Published: November 2021

Background
Rectal cancer patients who have undergone lower anterior resection with sphincter-saving surgery often experience loss of bowel control. We currently do not have suitable treatment regimens for such patients.

Objective
The aim of this study was to explore the experiences of losing bowel control in patients who have undergone lower anterior resection with sphincter-saving surgery for rectal cancer in Taiwan.

Methods
A descriptive phenomenological study design was adopted. Purposive sampling and one-on-one semistructured interviews were conducted for data collection. Narratives were analyzed using Colaizzi’s method.

Results
Data saturation was achieved after interviewing 12 patients (8 men, 4 women) whose average age was 61 years. Three themes and 11 subthemes emerged: physical problems (pain from broken perianal skin, insomnia, decreased physical strength, and body weight loss), adverse psychological reactions (worries, helplessness, and social isolation), and the use of coping strategies (avoidance of inappropriate foods to reduce bowel irritation and peristalsis, reduction of food intake, and use of antidiarrheal drugs and perianal skincare products).

Conclusion
The study supports the importance of having a good understanding of patient experiences by healthcare professionals to provide more effective healthcare. Furthermore, awareness of the cultural issue of social isolation was deemed important for providing individualized healthcare.

Implications for Practice
Education, counseling, and psychological support can enhance patients’ abilities to use coping strategies to overcome the physical and mental challenges of bowel symptoms. For example, appropriate diet-related education programs must be developed to reduce the trial-and-error learning process commonly adopted by patients to identify inappropriate foods.