Most employer schemes don’t embrace ESG investments For employers and intermediaries only.
Just one in ten employers believe their pension offering has actively embraced ESG investment options, according to research by Howden Employee Benefits & Wellbeing.
The research revealed just over 9% of respondents said their pension scheme is already strongly aligned with ESG requirements, while just 13% said their scheme is taking steps to understand and embrace ESG investments.
More than half of respondents (57%) revealed they did not know the current position of their scheme in relation to ESG investments.
This comes after regulations came into force in October 2019 which require schemes to set out their policy on financially material investment factors - including ESG considerations - in their statement of investment principles.
Howden suggested employers should also"be more aware of ESG pension scheme investments to avoid potential reputational damage".
Head of benefits strategy Steve Herbert said,"The reality is that the UK public is becoming increasingly aware of ESG investment issues.
"[It is a subject] that can spark fierce emotions in people. So it follows that we are likely to see many more challenges to pension schemes with regard to investments that are not seen as environmentally or socially acceptable."
He added,"Employers need to understand that, regardless of where the legally required investment duties may actually rest, there is an intrinsic and very public link between the sponsoring employer and its pension scheme offering in the minds of members, employees, customers, and the media.
"We urge employers to become more involved in, or at least aware of, their pension scheme's investment decisions with ESG guidance in mind."


Like many of the ancient and eroded craters in Mars’ southern highlands, these three craters have flattened rims, shallow floors, and have been filled with sediment in the four billion years since their formation. There is also evidence of ice here – the smallest crater has marks that are typically created as ice and debris creep across a surface, similar to how mixed rock-and-ice glaciers or debris-covered ice glaciers move in alpine regions of Earth.
This frame may once have contained other craters, as indicated by the round patches of sunken surface to the top right and bottom left. In fact, despite the cratered nature of Noachis Terra, the environment around this triplet is surprisingly smooth for such ancient terrain. Only a handful of small surrounding craters appear to have clear, sharply defined rims and bowls, indicating that they are relatively young and have not yet begun to erode in earnest. Overall, it seems that older craters in this area have ‘melted down’ into the surface – a phenomenon that is, again, due to ice.
As ice just under the surface of Mars flows and melts over many millions of years, the soil becomes softer. This soft, ice-rich soil subsides more quickly and fills up indentations and depressions more readily, contributing to the smooth appearance of this part of Noachis Terra. This suggests that there must have been a large amount of water present on Mars, at least during the Noachian period, capable of producing a glacier-like flow of abundant ice.


Earning an MBA is a milestone accomplishment — and one not without its challenges. The majority of students enrolled in an online MBA program will experience stress at some point during their academic experience, but there are ways to minimize it and respond productively.
These three tips will help you feel less stressed and more in control as you complete each course in your online degree program.
1. Designate time for studying and completing your coursework.
Online degree programs are known for their flexibility, and they are an ideal option for individuals with professional responsibilities who want to earn a higher-level degree. By creating a schedule with designated study hours, online students can be more consistent and successful. Set aside an hour or two each day, and make sure you stick to your schedule.
2. Prioritize self-care, and take time out to do things you enjoy.
When working full-time and completing coursework in your online MBA degree program, it might feel like there's no time left in the day for you. Each week, make sure to spend time doing something you truly enjoy. Whether that's exercising at the local gym, taking a yoga class with friends, or reading a book at the park, self-care should be a priority.
3. Reach out for support if and when you need it.
When you are not taking classes in a physical classroom, it can feel like you are on your own. Recognize that resources are available to you. If you feel stressed or overwhelmed with your current course load, contact an advisor or reach out to your professor. You might even want to connect with other students in the class to discuss how they are managing their responsibilities. It can help significantly to connect with the network of support that’s there for you.


Objective: Obstructive sleep apnea (OSA) syndrome is a common disorder that can cause hypercoagulation. Mean platelet volume (MPV) and platelet distribution width (PDW) are associated with hypercoagulability. This study aimed to investigate whether MPV and PDW values change in patients with OSA who were treated with continuous positive airway pressure (CPAP) device.


Public companies are required to keep investors and the public well informed concerning their financial condition. People rely on this information and expect it to be accurate. Accordingly, a company must file a restatement if it determines that its previous financial disclosures were inaccurate, and that people should not rely on them.
This blog touches on a few data points from an extensive report produced by two of our researchers, Joseph Burke, PhD, and Joseph Yarbrough, PhD. If you want access to the full report, email jcheffers@watchdogresearch.com. The analysis for this report was primarily derived from the Audit Analytics restatement database.
One thing to note is that restatements have declined significantly over the past ten years, although the rate of decline has slowed significantly.
This graph shows the annual share of companies filing one or more financial restatements from 2010 to 2019.
This decline should bring a great deal of comfort to many companies since restatements are one of the most harmful gray swan events that we track. Restatements are often the opening salvo in a torrent of bad press. A restatement often occurs because of a substantial material weakness in the internal controls and often can precipitate turnover in the management team, particularly at the CFO position. Additionally, restatements often trigger class action securities lawsuits.
Our analysis compared the returns over the thirty days following a restatement to the returns from the S&P 500 over the same timeframe. The data shows that the typical reaction of the market to a restatement is negative (approximately 2/3 of restatements resulted in negative returns). The most common result is negative returns from zero to 10%, but a significant portion (approximately 15%) had a negative return of 20% or more.
This graph groups companies by how their share prices performed in comparison with the S&P 500 in the 30 days after a restatement was reported.
Our analysis indicates that for many companies, issuing a restatement is a trying—but manageable—event. However, in a significant minority of cases, the losses can be catastrophic.
Some Notable Cases from 2019
Even though the percentage of companies impacted by a restatement in 2019 was relatively low, some of the restatements that did occur had a near record-breaking impact.
Pareteum Corp (TEUM) had a restatement in October, 2019, and lost 69.6% of its value over the next 30 days ($119 in market cap). TEUM’s decline in value (as a percentage of its pre-restatement value) over the thirty days following its restatement was more than any other company in the last ten years. TEUM was delisted in October 2020. Kraft Heinz (KHC) had a restatement in February 2019 that erased $12.7 billion in market cap after its restatement on February 9th, 2019. This loss in vale was the second largest in the last ten years. If you want to know more, you can read some of our analysis on KHC here, and here, and here. Baxter International Inc (BAX) had a restatement in October 2019 that erased $4.39 billion in market cap over the next thirty days. Even though BAX lost significantly less money than KHC, it was still the third largest loss of value in the last ten years. Conclusion
Restatements today are far less common than they were a decade ago, although the rate of decline has slowed in recent years. Our research also shows that 2/3 of restatements have a negative impact on share price. Although the response to a restatement is generally negative, people may be surprised by the fact that 1/3 of restatements had
no negative impact on the share price after 30 days.
Even though restatements are not as common as they used to be, a restatement can still be a catastrophic gray swan event, as is evident from the negative impact that they had on TEUM, KHC, and BAX in 2019.
These restatement numbers are just one facet of our Gray Swan Event Factor. With our GSEF we calculate the risk of gray swan events for over 4,500 publicly traded companies. If you would like a demo, email our President Brian Lawe via blawe@watchdogresearch.com.


AbstractClinical tools to guide in the appropriate treatment selection in immunoglobulin light chain (AL) amyloidosis are not well developed. We evaluated the response and outcome for various regimens at first-line treatment (n=681) and first progression (n=240) stratified by the immunoparesis status at diagnosis. Immunoparesis was assessed by the average relative difference of the uninvolved immunoglobulins, classifying patients into a negative average relative difference (i.e. significant immunoparesis) or a positive average relative difference (no/modest immunoparesis). Treatment was categorized as autologous stem cell transplant and four non-transplant regimens (melphalan-based; bortezomib-based, immunomodulatory drug-based and dexamethasone alone). Patients with significant immunoparesis who underwent stem cell transplant had a significantly lower rate of very good partial response or better response (58%), progression-free survival (median 30 months) and overall survival (108 months), compared to those without significant immunoparesis (80%, 127 months, median not reached, respectively; P<0.001 for all comparisons). Among the non-transplant regimens, melphalan resulted in an unfavorable progression-free survival (11 vs.27 months; P<0.001) and overall survival (30 vs.74 months; P=0.001) in patients with significant immunoparesis compared to those without significant immunoparesis. In contrast, no significant difference in outcomes between the immunoparesis groups was seen for those treated with bortezomib or immunomodulatory drugs. At first progression, immunoparesis status did not impact response or survival of any regimen. Melphalan at first-line provided poorer outcomes for patients with significant immunoparesis, while bortezomib or immunomodulatory drugs were more likely to overcome the adverse prognosis associated with significant immunoparesis. Introduction
AL amyloidosis is a disorder with considerable therapeutic challenges. The disease can produce profound organ dysfunction which may limit the intensity of the delivered treatment, and therefore treatment efficacy is impaired. Autologous stem cell transplantation (ASCT) is considered the treatment of choice, when applicable, given its superior long-term survival.21 However, for non-ASCT eligible patients, therapy selection based on baseline disease characteristics has not been well-developed. The lack of guidelines for treatment selection at diagnosis may lead to the selection of inappropriate treatment that would lead to irreversible organ damage and a shorter survival.
Recently, we have reported that significant immunoparesis is an adverse prognostic factor in newly diagnosed AL amyloidosis.3 We proposed that immunoparesis assessment can be carried out by two methods. First, qualitatively, considering the number of uninvolved immunoglobulins below their lower limit of normal (LLN) and second, quantitatively, in which the average relative difference (ARD) of the uninvolved immunoglobulins from their respective lower limits is assessed. It was found that patients with significant immunoparesis (represented by either a reduction of all the uninvolved immunoglobulins below the LLN or by a negative ARD value) had a higher rate of treatment failure and reduced progression-free survival (PFS) and overall survival (OS) compared to patients with no or only moderate immunoparesis. The quantitative assessment was, however, shown to have a better discriminate power for survival. In this study we explored the results of selected treatment regimens at induction and first progression and analyzed these outcomes based on the ARD status at diagnosis.
Methods
Six hundred and eighty-one patients (n=681) with systemic AL amyloidosis seen at the Mayo Clinic (Rochester, MN, USA) within 90 days of diagnosis between January 1, 2005 and August 31, 2015 were included. Data were extracted from a prospectively maintained database. The median follow-up of the surviving patients is 53 months (range 3–135 months). All patients gave written informed consent to have their medical records reviewed. The Mayo Clinic Foundation Institutional Review Board (IRB) approved this study.
Patients were excluded if they had prior treatment, amyloidosis associated with a lymphoproliferative disorder, an incidental positive bone marrow and/or fat aspirate without an amyloid-specific syndrome or a localized disease. Three hundred and seventeen patients who met inclusion criteria but lacked response evaluation data were not included in this study for the following reasons: no treatment/less than one cycle of treatment (n=58), lack of sufficient laboratory data for response evaluation, and/or early death rendering them inevaluable for response (n=259).
The diagnosis of AL amyloidosis was based on a tissue specimen positive for Congo red staining and with green birefringence under polarized light, followed by typing with immunohistochemistry, immunofluorescence, or mass spectrometry. All patients had immunoglobulin measurements before treatment. For immunoparesis assessment we used a quantitative measure, which utilizes the ARD of the uninvolved immunoglobulins. ARD was calculated as the mean value of the relative difference of the uninvolved immunoglobulins from their lower limit of normal (See the Online Supplementary File for a sample calculation). Based on this method, patients were stratified to those with a negative ARD value (i.e. significant immunoparesis) and those with a positive ARD value (i.e. no immunoparesis or modest immunoparesis only).
Treatment regimens at induction and first progression were grouped into autologous stem cell transplant (ASCT) and non-transplant regimens. The latter category includes the following regimen categories: melphalan-based regimen, bortezomib-based regimen (which includes 4 patients at first progression treated with other proteasome inhibitors) immunomodulatory drugs (IMiD)-based regimen (thalidomide, lenalidomide or pomalidomide), and dexamethasone alone. Eligibility criteria for ASCT at our center have been previously described.4
Two-hundred and ninety four patients (43% of the study population) progressed during follow-up. Of these, 51 patients (17%) progressed but were not treated and 3 additional patients had treatment of an unknown type. Therefore, 240 patients are evaluable for response and survival at first progression. Details of the specific regimens used at first-line of treatment and at first progression can be viewed in the Online Supplementary Material. For assignment of ARD group at first progression, we applied the baseline ARD groups at diagnosis, which represents an intrinsic feature of the disease not influenced by treatment.
The Pearson χ test and the Kruskal-Wallis test were used to ascertain differences between nominal and continuous variables, respectively. Evaluation of response, PFS and OS were performed in accordance with consensus criteria,5 the Kaplan-Meier method was used to measure survival analysis. Univariate Cox proportional regression analysis was used to examine the relationship between ARD groups, regimen types and survival outcome. P values less than 0.05 were considered significant. All statistical analyses were performed on JMP software (SAS, Cary, NC, USA).
Results Baseline characteristics
The median age of the 681 patients was 62 years [range 26–89]; 62% of patients were male. The median number of organs involved was 2 (range 1–4). The 2004 Mayo stage6 and the 2012 revised Mayo stage7 are listed in Table 1.
First line treatment
Induction treatment categories are listed in Table 1. A melphalan-based regimen was given to 32% of patients, bortezomib-based regimens to 19% of patients, an IMiD-based regimen to 5% of patients and dexamethasone alone for 2% of patients. Autologous stem cell transplant (ASCT) was performed in 32% of patients without prior induction, while an additional 10% of patients proceeded to ASCT following induction treatment making a total of 42% undergoing ASCT as a first-line treatment. There was no difference in treatment categories distribution, including ASCT, melphalan-based, bortezomib-based and IMiD-based regimens between immunoparesis groups (P=0.66), but not dexamethasone alone. Patients who underwent ASCT were younger (median age 59), with fewer organs involved (median one organ) and lower 2004 Mayo stage III (15%) and 2012 revised stages III–IV (25%), compared to patients treated with non-transplant regimens (median age 65; median involved organs 2; 2004 Mayo stage III 44%; 2012 revised stage III–IV 64%; all comparisons P<0.001). In patients who received non-transplant regimens, baseline characteristics were balanced between regimens in both immunoparesis groups (data not shown).
Hematological response to first-line treatment by immunoparesis status
The rate of very good partial response (VGPR) or better (≥VGPR) was 48% in patients with a negative ARD compared to 70% in patients with a positive ARD (P<0.001). While the rate of VGPR was similar between groups (25% and 26%, respectively), fewer patients in the negative ARD group reached a complete response (CR) compared to those with a positive ARD (23% vs. 44%). The rates of partial response and no response were 30% and 22% vs. 19% and 11%, respectively.
The rate of VGPR or better response by treatment categories can be seen in Figure 1. When comparing the ≥VGPR rate for each regimen between patients with a negative ARD to those with a positive ARD, the difference between groups was seen in those receiving ASCT (58% vs. 80%; P<0.001), a melphalan-based regimen (37% vs. 57%; P=0.006) and a bortezomib-based regimen (47% vs. 76%; P=0.001). However, no difference between groups was found in the IMiD-based regimen category (57% vs. 53%; P=0.81) or dexamethasone alone (25% vs. 50%; P=0.5)
Organ response by immunoparesis status
Organ response, (i.e. response in at least one involved organ) was seen in 57% of patients, and was significantly lower in patients with a negative ARD compared to those with a positive ARD (48% vs. 62%, respectively; P<0.001) (Figure 2). No difference in the achievement of organ response between the two immunoparesis groups was seen in those treated with ASCT (66% vs. 75%; P=0.12), a bortezomib-based regimen (48% vs. 56%; P=0.41), an IMiD-based regimen (54% vs. 43%; P=0.56) and dexamethasone alone (14% vs. 0%; P=0.59). However, for patients treated with a melphalan-based regimen, those with a negative ARD were less likely to achieve an organ response compared to those with a positive ARD (28% vs. 52%; P<0.001).
Effect of immunoparesis status on progression-free survival and overall survival by regimen type
Patients with a negative ARD, indicating significant immunoparesis, had a shorter PFS (median 16 months) compared to patients with a positive ARD [49 months, P<0.001; Hazard ratio (HR) 1.9, (95% confidence interval (CI) 1.5–2.3)]. The comparison of PFS between immunoparesis groups based on the given regimen demonstrated a significant difference in favor of the positive ARD group and was maintained in those undergoing ASCT [30 vs. 127 months, respectively, P<0.001; HR 2.3 (95% CI 1.6–3.2)] and for those treated with a melphalan-based regimen [11 vs. 27 months, P<0.001; HR 1.9 (95% CI 1.4–2.6)]. In contrast, no significant difference in PFS was noted between the negative and positive ARD groups in those treated with a bortezomib-based regimen [14 vs. 23 months, P=0.13; HR 1.4 (95% CI 0.9–2.3)], an IMiD-based regimen [20 vs. 13 months, P=0.84; HR 0.9 (95% CI 0.4–2)] or dexamethasone alone [5 vs. 6 months, P=0.66; HR 0.7 (95% CI 0.1–5)] (Figure 3).
Patients with a negative ARD had a shorter OS (median 66 months) compared to patients with a positive ARD [median 127 months, P<0.001; HR 1.6, (95% CI 1.3–2)]. In patients who underwent ASCT, inferior OS was seen in patients with a negative ARD (median 108 months) compared to patients with a positive ARD [median not reached, P=0.01; HR 1.9, (95% CI 1.1–3)]. Similarly, patients with a negative ARD treated with a melphalan-based regimen had an inferior OS compared to patients with a positive ARD treated with the same regimen type [30 vs. 74 months, P=0.001; HR 1.7, (95% CI 1.2–2.5)]. However, no significant difference in OS between immunoparesis groups was observed for a bortezomib-based regimen [57 vs. 41 months, P=0.61; HR 1.2, (95% CI 0.6–2.0)], an IMiD-based regimen [32 vs. 16 months, P=0.4; HR 0.7, (95% CI 0.3–1.6)] or dexamethasone alone [20 months vs. median not reached, P=0.57; HR 1.8, (95% CI 0.3–34)] (Figure 4). Of note, patients with a positive ARD treated with an IMiD-based regimen had a significantly shorter OS compared to other non-transplant regimens in this group (P=0.01).
Treatment at first progression
The progression rate in patients with a negative ARD was 53% compared to 39% in patients with a positive ARD (P<0.001). The median time to first progression was 14 months, shorter in patients with a negative ARD (12 months) compared to patients with a positive ARD (17 months; P=0.01). The characteristics of patients at first progression are listed in Table 2. The most common regimen used at first progression was bortezomib-based (53%), followed by IMiD-based (25%), melphalan-based (14%), ASCT (5%) and dexamethasone alone (3%). A different treatment distribution was noted at first progression by baseline immunoparesis status. Patients with a baseline negative ARD were more likely to receive a melphalan–based (18%) or an IMiD-based regimen (33%) compared to patients with a positive ARD (11% and 20%, respectively). In contrast, patients with a positive ARD were more likely to receive a bortezomib-based regimen (59%) compared to those with a negative ARD (44%). ASCT was used at a similar rate between groups (4% in the negative ARD groups and 6% in the positive ARD group) (P for all comparisons=0.02). Moreover, patients receiving a melphalan-based regimen at first progression were less likely to receive ASCT at first-line (30%) compared to other non-transplant regimens at first progression (49%; P=0.04), with no difference between ARD groups.
Response at first progression
The rate of VGPR or better at first progression did not differ between the immunoparesis groups. Fifty-seven percent of patients with a baseline negative ARD achieved ≥VGPR compared to 56% in patients with a positive baseline ARD (P=0.97). No difference was seen in the depth of response between groups (CR 19% vs. 15%; VGPR 23% vs. 28%, respectively; P=0.32). Organ response also did not differ between negative and positive ARD groups (42% vs. 40%; P=0.73).
The comparison of the rate of ≥VGPR by regimens between patients with a negative ARD to those with a positive ARD can be viewed in Figure 5. ASCT at first progression was utilized in 12 patients, and yielded the highest VGPR or better response rate (100% in patients with a negative ARD and 86% in patients with a positive ARD; P=0.46). As for the non-transplant regimens, no difference in the rate of ≥VGPR between the negative and positive ARD groups was noted for any regimen (melphalan-based regimen 29% vs. 43%, P=0.43; bortezomib-based 74% vs. 60%, P=0.14; IMiD-based 50% vs. 50%, P=1.0; dexamethasone alone 0% vs. 33%, P=0.39).
Survival from first progression
PFS from first progression was comparable between those with a negative ARD and those with a positive ARD (median 17 vs. 20 months, respectively, P=0.95; HR 1 95% CI 0.7–1.4) (Figure 6A). No significant difference in PFS was seen between the negative and positive ARD groups for any regimen at first progression [ASCT median not reached in both, P=0.23; HR not estimable); melphalan-based median 8 months vs. 13 months, P=0.36; HR 1.5 (95% CI 0.6–3.5); bortezomib-based 27 vs. 22 months, P=0.64; HR 0.9 (95% CI 0.5–1.5); IMiD-based 17 months both, P=0.59; HR 0.8 (95% CI 0.4–1.7); dexamethasone alone 3 vs. 7 months, P=0.17; HR 5.5 (95% CI 0.2–138)].
OS from first progression was similar between groups [median 42 months in those with a negative ARD compared to 47 months in those with a positive ARD, P=0.65; HR 1.1 (95%CI 0.8–1.5)] (Figure 6B). No significant difference in OS was seen between the negative and positive ARD groups for any given regimen at first progression [ASCT median not reached in both groups, P=0.18; HR not estimable; melphalan-based median 31 months vs. 40 months, P=0.9; HR 0.9 (95%CI 0.4–2.5); bortezomib-based median not reached vs. 72 months, P=0.42; HR 0.8 (95%CI 0.4–1.4); IMiD-based 54 months vs. 68 months, P=0.95; HR 1 (95%CI 0.5–2.2); dexamethasone alone 5 vs. 37 months, P=0.17; HR 5.5 (95%CI 0.2–138)].
Discussion
This study provides data on the differential response to various chemotherapeutic regimens in AL amyloidosis at first-line and first progression stratified by the immunoparesis status at diagnosis. For newly diagnosed patients, ASCT provided the best outcomes within each immunoparesis group, but with a greater benefit seen in patients without significant immunoparesis (i.e. positive ARD) compared to those with significant immunoparesis (i.e. negative ARD). For non-transplant first-line regimens, a comparison between immunoparesis groups shows that while the advantage for those with a positive ARD was seen with a melphalan-based regimen, this advantage disappeared with bortezomib or IMiD-based regimens. The response and outcome at first progression were comparable between immunoparesis groups, suggesting neutralization of the adverse prognostic effect of immunosuppression at progression. However, when the data was analyzed by regimen, melphalan-based and dexamethasone alone generally produced poorer response and survival compared to other regimens, possibly reflecting selection bias.
ASCT provided an improved survival rate in each immunoparesis group. The advantage of ASCT was seen as a higher rate of ≥VGPR as well as a longer PFS and OS. ASCT is, however, applicable only in a fraction of patients, which carry a more favorable prognosis, as reflected by younger age, a median of one involved organ and lower risk-stratified stage. In this study, ASCT (with or without prior induction) was performed in over 40% of patients, and reflects a referral bias. It is important to note that although patients with significant immunoparesis were shown to have more cardiac involvement, less renal involvement and a higher tumor burden (dFLC, bone marrow plasma cell percentage),3 they were as likely to proceed to ASCT as those without significant immunoparesis (41% vs. 43%, respectively). Even with ASCT, patients with a negative ARD had a lower ≥VGPR rate, PFS and OS compared to patients with a positive ARD, although organ response was achieved at a similar rate (66% vs. 75%, respectively). It appears that ASCT is the treatment of choice regardless of immunoparesis status, but response and response duration in patients with significant immunoparesis are lower than in those without significant immunoparesis.
Exploration of the treatment options in the non-transplant regimens reveals that patients with significant immunoparesis had a poorer response to melphalan-based regimens. This was reflected by a low rate of ≥VGPR (which represents the therapeutic endpoint in AL amyloidosis),7 as well as significantly lower organ response rate. In comparison, patients lacking significant immunoparesis treated with similar regimens had higher hematological (57%) and organ response (53%) rates. Moreover, a PFS and OS advantage in favor of patients without significant immunoparesis was seen in those treated with high-dose melphalan or low-intensity melphalan, but not for bortezomib or IMiDs. This finding suggests that in ASCT ineligible patients, melphalan has a greater impact in those without significant immunoparesis, while those with significant immunoparesis are less likely to benefit from melphalan. The reason for this is unclear, but might reflect different disease biology based on immunoparesis status. Melphalan, an alkylating agent is, unlike bortezomib and IMiDs, genotoxic.8 As such, it has the potential to impact DNA integrity and accelerate progression of a genomically unstable plasma cell clone. At progression, melphalan therapy produced the poorest results, which also supports this hypothesis. However, this clearly needs further investigation.
While IMiDs produced a relatively good response rate and survival in patients with significant immunoparesis, they were associated with a reduced OS in patients without significant immunoparesis. IMiDs in AL amyloidosis are generally not well tolerated and produce modest benefit,109 and therefore are not considered as first-line treatment for most patients. Based on the data presented, the selection of an IMiD as first-line should be discouraged in those without significant immunoparesis but can be considered for those with significant immunoparesis. The number of patients treated with IMiDs in this study was small, so this conclusion must be taken with caution and should be confirmed by other studies. When dexamethasone alone was utilized, the results were generally poor.
Patients at first progression were still able to achieve ≥VGPR in over 50% of patients in both groups, but had a shorter duration of response with a second-line of therapy. PFS and OS were comparable between patients with or without significant immunoparesis, independent of the salvage regimen. However, patients treated with melphalan-based regimens had poorer response, PFS and OS in immunoparesis groups. This may reflect a bias, as patients treated with low-dose melphalan at first progression were less likely to have been ASCT-eligible at diagnosis and carry a poorer prognosis.
In conclusion, first-line ASCT provides the best response and survival in patients with AL amyloidosis, irrespective of immunoparesis status. Better results for ASCT, however, were seen in those without significant immunoparesis. For non-transplant regimens, bortezomib and IMiDs were more likely to overcome the poorer prognosis associated with significant immunoparesis, while low-dose melphalan was associated with the least benefit for patients with significant immunoparesis. These findings should be assessed in prospective studies.
Footnotes Check the online version for the most updated information on this article, online supplements, and information on authorship & disclosures: www.haematologica.org/content/101/9/1102 Received March 29, 2016. Accepted June 10, 2016. References D’Souza A, Dispenzieri A, Wirk B. Improved Outcomes After Autologous Hematopoietic Cell Transplantation for Light Chain Amyloidosis: A Center for International Blood and Marrow Transplant Research Study. J Clin Oncol.2015; 33(32):3741-3749. PubMedhttps://doi.org/10.1200/JCO.2015.62.4015Google Scholar Cordes S, Dispenzieri A, Lacy MQ. Ten-year survival after autologous stem cell transplantation for immunoglobulin light chain amyloidosis. Cancer.2012; 118(24):6105-6109. PubMedhttps://doi.org/10.1002/cncr.27660Google Scholar Muchtar E, Dispenzieri A, Kumar SK. Immunoparesis in newly diagnosed AL amyloidosis is a marker for response and survival. Leukemia.2016. https://doi.org/10.1038/leu.2016.140Google Scholar Dispenzieri A, Buadi F, Kumar SK. Treatment of Immunoglobulin Light Chain Amyloidosis: Mayo Stratification of Myeloma and Risk-Adapted Therapy (mSMART) Consensus Statement. Mayo Clin Proc.2015; 90(8):1054-1081. PubMedhttps://doi.org/10.1016/j.mayocp.2015.06.009Google Scholar Comenzo RL, Reece D, Palladini G. Consensus guidelines for the conduct and reporting of clinical trials in systemic light-chain amyloidosis. Leukemia.2012; 26(11):2317-2325. PubMedhttps://doi.org/10.1038/leu.2012.100Google Scholar Dispenzieri A, Gertz MA, Kyle RA. Prognostication of survival using cardiac troponins and N-terminal pro-brain natriuretic peptide in patients with primary systemic amyloidosis undergoing peripheral blood stem cell transplantation. Blood.2004; 104(6):1881-1887. PubMedhttps://doi.org/10.1182/blood-2004-01-0390Google Scholar Kumar S, Dispenzieri A, Lacy MQ. Revised prognostic staging system for light chain amyloidosis incorporating cardiac biomarkers and serum free light chain measurements. J Clin Oncol.2012; 30(9):989-995. PubMedhttps://doi.org/10.1200/JCO.2011.38.5724Google Scholar Ranaldi R, Palma S, Tanzarella C, Lascialfari A, Cinelli S, Pacchierotti F. Effect of p53 haploinsufficiency on melphalan-induced genotoxic effects in mouse bone marrow and peripheral blood. Mutat Res.2007; 615(1–2):57-65. PubMedhttps://doi.org/10.1016/j.mrfmmm.2006.10.001Google Scholar Dispenzieri A, Lacy MQ, Rajkumar SV. Poor tolerance to high doses of thalidomide in patients with primary systemic amyloidosis. Amyloid.2003; 10(4):257-261. PubMedhttps://doi.org/10.3109/13506120309041743Google Scholar Sanchorawala V, Wright DG, Rosenzweig M. Lenalidomide and dexamethasone in the treatment of AL amyloidosis: results of a phase 2 trial. Blood.2007; 109(2):492-496. PubMedhttps://doi.org/10.1182/blood-2006-07-030544Google Scholar


Cyclization via head-to-tail linkage of the termini of a peptide chain occurs in only a small percentage of proteins, but engenders the resultant cyclic proteins with exceptional stability. The mechanisms involved are poorly understood and this review attempts to summarize what is known of the events that lead to cyclization. Cyclic proteins are found in both prokaryotic and eukaryotic species. The prokaryotic circular proteins include the bacteriocins and pilins. The eukaryotic circular proteins in mammals include the theta defensins, found in rhesus macaques, and the retrocyclins. Two types of cyclic proteins have been found in plants, the sunflower trypsin inhibitor and the larger, more prolific, group known as cyclotides. The cyclotides from Oldenlandia affinis, the plant in which these cyclotides were first discovered, are processed by an asparaginyl endopeptidase which is a cysteine protease. Cysteine proteases are commonly associated with transpeptidation reactions, which, for suitable substrates can lead to cyclization events. These proteases cleave an amide bond and form an acyl enzyme intermediate before nucleophilic attack by the amine group of the N-terminal residue to form a peptide bond, resulting in a cyclic peptide.


Commercial Real Estate Law in Michigan
In Frankenmuth, Michigan, commercial real estate is any form of real property (land or permanent structures) being utilized for business purposes.
Commercial real estate in Frankenmuth, Michigan is controlled by laws which differ significantly from state and local laws that apply to residential real estate.
Buyers and renters of residential property enjoy some pretty considerable legal protections, because the law of most states presumes that shelter (being necessary to survive, for the most part) is more important than business. Therefore, many of these consumer protections don't apply to commercial real estate.
These include implied warranties of habitability, rent control, and covenants of use and quiet enjoyment, among various others. Of course, the most general protections, such as prohibiting the seller from actively concealing defects, apply to both.
Common Commercial Real Estate Law Issues in Frankenmuth, Michigan
Financing: The majority of small businesses in Frankenmuth, Michigan can't afford to make large real estate purchases with the money they have in the bank. Nonetheless, buying real estate is sometimes necessary for a business' survival. This problem is sometimes remedied by taking out a mortgage; a loan used to buy property, with that same property being used to secure the loan.
Duty to Disclose Defects: It is of the utmost importance that sellers and lessors of commercial real estate be up front about any defects that might be present in the property. Failing to disclose them can be bad, and actively concealing them can be much worse. In general, if a defect is significant enough that it would influence a reasonable person's decision to buy a piece of property, and the seller knows about it, the seller should disclose it. Failure to disclose can have significant outcomes. If the buyer later discovers the defect, they can sue for the cost of repairing it, or for any reduction in the property's value caused by it. And, of course, if it causes any injuries, the buyer can sue the seller for those, as well.
Duty to Inspect: Lest you believe that the duty to disclose defects relieves any duty of diligence on the part of the buyer, the law will not reward such lapses with a major cause of action. Buyers have a duty to conduct a reasonable inspection of the property before they buy it, normallyy with a licensed building inspector. If the buyer fails to do this, they won't be able to recover any damages for defects which they could have discovered through a reasonable inspection.
Encumbrances: Encumbrances are defects of a different type: rather than physical defects, they are defects of title. In Frankenmuth, Michigan, an encumbrance is an interest in a piece of real estate held by a third party, such as covenants or easements. An easement is a right held by someone to use the property of someone else for a particular purpose. For instance, a person might have an easement on the land of another person, allowing them to cross the land to access a public road.
Can a Frankenmuth, Michigan Attorney Help?
These issues can be very complicated, and most people consider such financially-weighty decisions to be very essential. If you are one of those people, it's a smart move to contact a Frankenmuth, Michigan real estate attorney if you are facing any of the issues discussed above.


For some women, frequent urination can be a sign of pregnancy. However, what if urinating is accompanied by pain whether it be a sign of pregnancy or even a dangerous condition of a particular disease?
When pregnant, women will become frequent urination. This condition is generally normal and can be used as one of the early signs of pregnancy. Increased frequency of urination occurs because the body undergoes hormonal changes, as well as the enlarged uterus that suppress the bladder, causing frequent urination during pregnancy.
While for urination accompanied by pain, although often also experienced by pregnant women, is not a sign of pregnancy. This condition is a symptom of certain diseases, such as bacterial vaginosis, chlamydia, endometriosis, genital herpes, gonorrhea, trichomoniasis, or urinary tract infection (UTI). Not only pregnant women who can experience pain when urinating, women who are active in sexual intercourse are also at risk of experiencing it.
The Cause of Pain When Urinating The Cause of Pain When Urinating
Pain during urination can be the most common symptoms when you have a urinary tract infection or UTI. This condition often occurs during pregnancy, because the influence of pregnancy hormones and changes in the size of the uterus that suppress the bladder can cause the emptying of the urine becomes disrupted.
Women are also at higher risk of developing urinary tract infections than men. This is because women's urinary tract is shorter than men's urinary tract. As a result, bacteria from around the anus can easily enter into the bladder and then infect it. Not only in the urinary tract, UTI can also occur when bacteria attack other urinary tract systems, such as kidney, ureter, and bladder (cystitis). Pregnant women, menopausal women, and women who are sexually active are at increased risk of bladder infections.
Signs and symptoms that occur when a urinary tract infection, including:
Sensation of pain during urination Feeling often want to urinate The color of the urine is cloudy Fever The stench of urine Pain in the pelvis and lower abdomen There is blood in the urine
If you experience UTI symptoms during pregnancy, consult your doctor immediately for the right treatment. This needs to be done so that bacteria do not spread upwards and cause kidney infections (pyelonephritis) or cause complications in the fetus.
Preventing Urinating Painfu l Preventing Urinating Painfu l
Urinary tract infections may adversely affect the fetus, leading to premature birth, or low birth weight infants. Therefore, urinary tract infections during pregnancy should be addressed and prevented as much as possible. Here are some steps to prevent urinary tract infections, among others:
Drink plenty of water. Fulfill your nutritional intake, such as vitamin C, beta-carotene, and zinc that can strengthen the immune system in fighting infection. Avoid holding back, because emptying your bladder can prevent bacteria from multiplying. After urinating or defecating, wipe off using a tissue or water from the front to the back (from the vagina to the anus). It aims to prevent the spread of bacteria from the anus to the vagina or to the urinary tract. Avoid foods and drinks that can irritate the bladder, such as spicy foods, artificial sweeteners, alcohol, caffeine, and sour fruits. Avoid feminine hygiene products in the form of sprays, powders, and antiseptic soaps that can irritate your urinary tract and female organs. Keep your urinary tract clean by changing underwear every day. In addition, choose underwear cotton and not too tight to prevent the feminine area becomes damp. Use condoms when having sex to prevent the occurrence of sexually transmitted diseases.
These simple things can prevent you from the pain of urination caused by UTI during pregnancy. However, if you are already exposed to the UTI, immediately consult a doctor to get the right handling. It should be done to prevent complications in pregnancy, such as premature babies, low infant weight, premature rupture of membranes, and preeclampsia.


SUMMARY: Unmanned aircraft systems can be an incredibly effective tool for companies looking to quickly and safely assess damage from major storms and disasters.
PROBLEM: Exceptionally high floodwaters from Hurricane Matthew remain too deep for cars to traverse in some towns along the U.S. Carolina coast. Many buildings appear too damaged to accommodate inspections safely.
SOLUTION: Companies are turning to UAS's to assist with the post-storm damage assessment and recovery effort. Verizon is using a unmanned aircraft operated by a partner company to assess potential damage at cellular site locations that are still covered by floodwater. After the drone flight, Verizon was able to send a boat with technicians who restored service near the Tar River Reservoir. Allstate insurance is also using drones to assess property damage in Savanah, Georgia. Instead of having a claims inspector ascend to the roof of a house to inspect damage from a fallen tree, Allstate dispatched a drone to capture a bird's-eye photo of the roof, which they deemed to be both faster and safer then having a person climb a compromised structure.


A Student Emergency Fund was established in March to support Augsburg students with financial relief as we all grapple with the challenges of COVID-19. In these disruptive times, many students are experiencing the loss of income and jobs as segments of the economy shut down, struggles to provide for their families, obstacles in returning home to out-of-state residences, and uncertainty about their ability to finance their Augsburg education.
With this fund, students are able to request emergency funding for basic needs, including food, rent, transportation, and medication. They may also request funding for academic materials—such as books, supplies, laptop computer rentals, and wireless internet—to ensure their education is not impacted by a lack of attainable resources.
Give to the Student Emergency Fund at augsburg.edu/giving.


Purpose
To provide Biophysical Society members, biophysicists, and others interested in the field with information related to biophysics research & careers, BPS activities, science news, member news, and public policy matters. BPS maintains accounts on Facebook, Instagram, LinkedIn, and Twitter.
While social media is an effective communication and promotional tool, unguided engagement may lead to negative public reaction and consequences to BPS, therefore, it is important to develop a general framework and policy to guide our social media engagement to maximize effectiveness and minimize risks.
Social Media Posting Guidelines
Considering the diverse content that is shared on BPS social media, there are general guidelines that every post should adhere to and specific guidelines for posts around BPS sponsored events. Posts and Tweets, including reposts and retweets, should be in keeping with the Society’s mission, goals, and values. Posts should fall within the scientific efforts and/or expertise. Remember that BPS represents science and posts should be related to non-partisan science, which means that even reputable sources may not be suitable for citing or posting.
General Guidelines: Posts will be clear, concise and factual in nature. Questionable content must be verified with credible sources before posting. Any posts that share a link to a third-party website will be vetted and verified ahead of time. Posts will not communicate any financial, operational or proprietary information about BPS or its members. As BPS is a 501(c)3 organization, BPS may face tax consequences for public statements directly or indirectly supporting a political campaign or specific candidate for public office. No posts will identify any partisan political preferences or promote specific political campaigns. However, posts highlighting a general group of scientists or STEM candidates running for office is permissible. Posts will avoid using language that is deemed derogatory, offensive, or inflammatory. BPS representatives are barred from utilizing BPS social media assets to communicate their personal views or opinions. Violators will be subjected to administrative action. BPS accounts will make clear that its retweets or posting re-sharing content by another user does not indicate an endorsement of that user’s statement by BPS. Posts/reposts will be selected that represent the diversity of voices within the Society In the event BPS social media accounts receive a negative post or comment, the Social Media Manager will determine the best response or appropriate person(s) to whom to escalate the issue. In the event BPS social media accounts receive a request to engage on a specific policy issue, sign a petition, or share a particular viewpoint, these posts will be immediately shared with the Public Affairs Director for vetting. The Public Affairs Committee will consider relevant policy issues originating from social media to engage with. Specific Guidelines:
BPS Events: No photos from BPS events will be shared that feature staff or members holding alcoholic beverages If BPS events are sponsored by outside organizations, posts will feature and thank our sponsors for their participation.
Members of Congress/Public Officials BPS posts will only tag and engage with the official account of the public officeholder. Staff will ensure no political accounts are tagged. BPS will engage with and support public office holders that support BPS positions and the research enterprise in general, regardless of their political affiliation.
Official BPS Statements or Press Releases Due to character limits, it is often difficult to fully describe an official statement or press release on social media. Posts that share BPS positions or releases will always feature a link to the full statement/release and, to the best of their ability, summarize the position. Readers will be encouraged to view the full statement/release to ensure accurate and effective communication.
Chapters and Subgroups
Chapters and subgroups are required to adhere to all of the Society’s general social media guidelines. Chapters’ and subgroups’ social media presence is a powerful tool. It provides an avenue to build relationships and engage people. Official BPS Student Chapters and subgroups are an extension of the Biophysical Society. Every social media channel used by chapters and subgroups may be a first impression of the organization and should properly reflect the chapter, subgroup, institution, and Society. Each chapter and subgroup’s different social media channels should reflect the diverse voices that speak for the Biophysical Society. However, they should be representative of the Society’s missions and goals and identifiable as an official BPS associated account. All such accounts should feature the BPS logo along with the Chapter or subgroup logo in a clearly identifiable way.
Part of the chapter and subgroup’s identity lies in the tone or voice that is used to represent the chapter, subgroup, institution, or the Society. Consider how the language you use affects or enhances the credibility of the chapter, subgroup, institution, and the Society. A motto often used when dealing with social media is that you can relax your tone, but not your standards. This means you should keep updates conversational and friendly, but always be a source of information and never uninformed speculation.
Violation of BPS Social Media Policy Guidelines
To avoid any adverse repercussions, please adhere to the BPS Social Media Policy Guidelines. Violators may jeopardize their relationship with BPS and will be prohibited to interact on behalf of BPS and its affiliates.


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Scientific/Medical Question 13 What is the MDT and explain the role of 5 key MDT members
MDT stands for multidisciplinary team. The MDT is crucial to integrated patient care, enabling successful collaboration of of professionals across the health and social care professions. Five team members are as follows: Excellent Answer
Excellent Answer
Doctors - doctors assess patients, request/perform investigations, prescribe medications and perform procedures. In conjunction with the patient , they strategise the direction that treatment will take.
Nurses: a nurse’s role involves planning, administering and evaluating patient care - such as diet, medications, monitoring vital signs, and ensuring record keeping.
Pharmacists: a clinical pharmacist is responsible for ensuring correct prescribing - be it checking that medications are correct, or that they follow national or local guidelines.
Physician associate: a physician associate is a medically trained healthcare professional who works alongside doctors to provide medical care. They can see patients, formulate diagnoses, and perform procedures. However, they cannot prescribe and must work within a scope and with a dedicated medical supervisor.
Occupational therapist: occupational therapists have a degree in Occupational Therapy. They work in the rehabilitation of patients, with the goal of helping recovery in occupational and day-to-day skills. They also assess patient function across areas that are relevant to their return to everyday life, and develop a program to help them as needed.


Married ladies, be honest: Have you ever tried to plan your “escape” if things got too risky or too demanding? This wife shares why she decided to trade her escape plan for full commitment instead.
For as long as I can remember, I’ve been a planner, strategically and intentionally moving through life with plans A, B, and C intact — and, if I’m candid, marriage was no different. Even walking down the aisle, I knew that if this “Black love thing” didn’t work, I would have a plan to “abort mission” and safely route myself back to my independent, well-educated, much-loved single women’s utopia in Brooklyn.
Don’t get me wrong, I was committed, but I’d be lying if I said there were no caveats.
See, before dating my husband, I had experienced a plethora of healthy, happy relationships, both romantic and platonic. However, there were always contingencies to keep me in control. As an independent woman, I felt I needed boundaries and a clear path out if things got too risky or too demanding. Ensuring that I always had an escape plan made me feel prepared in life and ultimately prepared for whatever deal-breakers a relationship, or a marriage, would (in my mind) inevitably bring my way. Looking back now, I realize that these beliefs were rooted in nothing more than fear.
As an independent woman, I felt I needed boundaries and a clear path out if things got too risky or too demanding.
A year into our marriage, we got into one of our routinely, unruly quarterly arguments that resulted in me almost unconsciously plotting my exit. Like many times before, I thought through plans B, C, and D without saying a word, but this time was different. This time, instead of keeping the feud going for weeks, my husband came to me and said, “Let’s start over.” I agreed. I was skeptical, but amid my hesitation, I saw a glimmer of our growth.
After we’d reconciled and had a chance to talk sensibly, my husband jokingly called me a “flight risk.” Offended, I reacted immediately with anger, and there went all of our growth right out the window. Sitting alone in the bathroom, with the notion of being compared to a fugitive top of mind, I realized that I’d been indeed behaving like someone in captivity contemplating an escape. What had once been my testament to “staying ready” and in control was consequently preventing me from living freely and choosing to love him wholeheartedly. He had joked, but the reality was, I was a flight risk, and we both knew I hadn’t been fully committed.
I was a flight risk, and we both knew I hadn’t been fully committed.
It was apparent then, that if I wanted to experience the abundance of a loving, happy marriage, I would eventually need to abandon my marriage contingency plan and consciously choose to show up for our love and our marriage wholeheartedly, with no plan-B in-tact.
It was also the first time that I’d acknowledged that my crisis planning and what-if strategies were getting in the way. From the moment we’d said, “I do,” I’d been planning my exit to avoid marital challenges, mitigate generational hurt, and escape the possibility of disappointment. Marriage was the most permanent situation I’d ever been in, and, up until that point, I needed to believe there was a clear way for me to get out unscathed. Not knowing that sometimes coming out of a situation unscathed is a direct correlation to being uncommitted.
Changing my mindset came with several unfamiliar challenges, but now I know that’s what marriage is all about. The first step I took was to remove the option of leaving altogether. Doing this took work and recalibration. I still needed options, but escaping couldn’t be one of them. Now, instead of contemplating jumping ship when things get hard and allowing fear to lead, I choose to lean-in and dig for multiple solutions. Sometimes I find them, sometimes I don’t, but usually, we explore the options together.
The second significant change I made was to relinquish some control. Marriage is a partnership, and we are equal stakeholders in our union. I had to learn to trust him and believe that as my husband, he has my best interest in mind.
Lastly, I had to get clear on what the actual deal-breakers were because let’s be honest, they exist. However, being transparent with each other about deal-breakers is key. This way, you know that you’re on the same page and honoring the same values.
Oh, and I still make contingency plans, but now they include alternatives and strategies for us both. I’ve learned that having a plan in place to mitigate our disagreements and help navigate our thoughts and emotions when things get rocky, is ideal.
As a married woman, most days I wake up uncertain, and with fewer plans than I did the morning before, but one thing is for sure, every day without a doubt I wake up, and I choose our love.


Abstract:
Objective: To examine the relationship between poor effort, as measured by performance on the Word Memory Test, and baseline performance on ImPACT. Methods: Twenty-five undergraduate volunteers completed the immediate and delayed recall subscales of the WMT, as well as baseline testing on ImPACT. Results: Pearson’s correlations revealed a significant relationship between WMT scores (percent correct) and ImPACT processing speed composite score (r = .58; P = .003). Ten participants who failed the WMT (below 95% correct) had significantly faster ImPACT processing speed composite scores [F(1, 23) = 5.03; P = .035], as compared to 15 participants who completed the WMT at 95–100% correct. One-way ANOVAs revealed no significant between-groups differences on the other four ImPACT composite scores, including Impulse Control. Conclusions: Individuals performing with sub-optimal effort appear to process ImPACT stimuli faster than individuals completing the test with full effort. While this might suggest individuals providing sub-optimal effort are choosing any answer as quickly as possible, this is not reflected by poor performance on the other four composite scores. These results suggest that effort testing should be included in baseline concussion assessment, as decision time/processing speed is compromised by poor effort. In those cases where individuals provide sub-optimal effort, performance on baseline testing should be carefully scrutinized with particular emphasis on accuracy and speed of responses. Further research is required to determine the response patterns of individuals providing sub-optimal effort on specific neuropsychological test measures, especially those measuring response time on a computer.


Older people have lived a long time and may have had a lot of previous health problems. They may arrive in ED, convinced that they have a specific problem, “just like the last time”.
Important Note
Because older patients present atypically, we must consider their condition carefully. Keep an open mind:
the nausea associated with the current MI may feel like nausea of the previous ulcer; the flank pain of the current leaking AAA may feel the same as the previous ureteral stone; The unilateral headache of the current spontaneous subdural hematoma may feel similar to the hemicranial pain of the previous migraines!; The mild confusion of the current pneumonia may look to the family the same as the last time Mom had a UTI


Background
Midwives are expected to support women with lactation initiation and maintenance. Midwifery students engaged in a simulation-based exercise (LactSim OSCE) where they role-played the clinician and the breastfeeding patient by wearing a high-fidelity breast model. We provided participants opportunities for reflecting in and on practice to compare their perceived self-confidence in clinical lactation skills to actual clinical performance. We also describe feasibility of implementing the LactSim OSCE with an emphasis on preparation and time spent on tasks during the OSCE.
Methods
Audio-video recordings from the LactSim OSCE were viewed and assessed using a technical skills checklist by an independent rater and by the study participants as part of the self-reflection. Mixed data on participants’ self-efficacy in clinical lactation, experience with the LactSim OSCE, and self-assessment of clinical performance were collected in survey instruments and a focus group. Time spent on each component and clinical lactation skill during the LactSim OSCE was documented.
Results
Immediately following the LactSim OSCE, participants’ confidence in clinical lactation was high (5.7/7), but after a guided video reflection exercise, their self-efficacy was 4.4/7. Participants spent approximately 2 of the allotted 10 min per case scenario discussing the OSCE logistics due to inadequate preparation. Participants spent approximately 2 min of the total encounter performing hands-on clinical lactation skills by touching, looking at, or using the high-fidelity breast model worn by their peer.


Abstract
Bartonella species were isolated from the blood of 63 of 325 Rattus norvegicus and 11 of 92 Rattus rattus from 13 sites in the United States and Portugal. Infection in both Rattus species ranged from 0% (e.g., 0/87) to ~60% (e.g., 35/62). A 337-bp fragment of the citrate synthase (gltA) gene amplified by polymerase chain reaction was sequenced from all 74 isolates. Isolates from R. norvegicus were most similar to Bartonella elizabethae, isolated previously from a patient with endocardil is (93%-100% sequence similarity), followed by Bartonella grahamii and other Bartonella species isolated from Old World rodents (Clethrionomys species, Mus musculus, and Rattus species). These data suggest that Rattus species are a reservoir host for pathogenic Bartonella species and are consistent with a hypothesized Old World origin for Bartonella species recovered from Rattus species introduced into the Americas.
ASJC Scopus subject areas Immunology and Allergy Infectious Diseases


What is Unconventional Oil?
Unconventional oil refers to oil reserves that cannot be feasibly accessed using conventional drilling techniques. These reserves – notably tight oil, oil shale, and bitumen – must be extracted using novel methods. In contrast, conventional oil typically refers to crude oil which uses conventional vertical drilling techniques. There is no fixed definition for conventional and unconventional resources, and may be subject to change over time as technology and economics change
1. Tight Oil
Tight oil describes reserves where the oil is trapped in geologic formations with low permeability, like shale or tight sandstone. The most common method of extraction for tight oil is hydraulic fracturing
2. Oil Sands
The oil sands are large deposits of bitumen – grains of sand enveloped by layers of water and heavy oil. While the existence of bitumen has been known for quite some time, it is only recently (in the last 50 years) that technology and economic circumstances have allowed it to be extracted. These deposits, notably in Western Canada and Venezuala, can be accessed by surface mining or in-situ techniques.
Oil Shale
Oil shale is a fine grained sedimentary rock containing an organic compound known as kerogen, a precursor to oil. The extracted rock can be heated in an oxygen free environment to yield different hydrocarbon products; this is known as “retorting”
3. Video Context
Unconventional oil resources are typically more expensive to produce than conventional oil, often in the $40-$80/barrel range for production. However, the production of unconventional oil is increasing due to rising demand for fossil fuels and falling reserves of conventionals.
The unconventional oil “revolution” has drastically changed the world energy landscape. Advances in technology have made previously hard-to-access oil reserves more economically recoverable. These advancements have triggered changes in global oil supply, demand and transport. It has also affected global energy access and national economies. Perhaps the most notable effect is in the US, which is estimated to transition from a historical oil importer to a net exporter of oil by the end of the decade due to the exploitation of tight oil. This change in the US has drastically affected the global market for oil
4. Dive deeper Recent blog posts about Unconventional Oil
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Anna Trenaman, Lucy Glover, Sebastian Hutchinson and David Horn
Nucleic Acids Res. 2019 Jul 26; 47(13): 7063–7077.
Published online 2019 May 25. doi: 10.1093/nar/gkz455 Abstract
Post-transcriptional regulons coordinate the expression of groups of genes in eukaryotic cells, yet relatively few have been characterized. Parasitic trypanosomatids are particularly good models for studies on such mechanisms because they exhibit almost exclusive polycistronic, and unregulated, transcription. Here, we identify the Trypanosoma brucei ZC3H39/40 RNA-binding proteins as regulators of the respiratome; the mitochondrial electron transport chain (complexes I–IV) and the FoF1-ATP synthase (complex V). A high-throughput RNAi screen initially implicated both ZC3H proteins in variant surface glycoprotein (VSG) gene silencing. This link was confirmed and both proteins were shown to form a cytoplasmic ZC3H39/40 complex. Transcriptome and mRNA-interactome analyses indicated that the impact on VSG silencing was indirect, while the ZC3H39/40 complex specifically bound and stabilized transcripts encoding respiratome-complexes. Quantitative proteomic analyses revealed specific positive control of >20 components from complexes I, II and V. Our findings establish a link between the mitochondrial respiratome and VSG gene silencing in bloodstream form T. brucei. They also reveal a major respiratome regulon controlled by the conserved trypanosomatid ZC3H39/40 RNA-binding proteins.


EIGA 225/19 – Solvents for acetylene filling
The previous publication of EIGA 123, Code of Practice Acetylene, had become very large. During its review it is being split into separate publications on different topics. One of the topics is solvents for acetylene.
Acetylene is a chemically unstable gas which can decompose violently under pressure. The acetylene gas is dissolved into a liquid solvent within the cylinder to improve the acetylene's chemical stability. This reduces the hazards involved in filling, transport and use.
This publication explains the safe use of solvents with acetylene. It describes the properties of the two solvents used for acetylene filling, acetone and dimethylformamide (DMF). It highlights the properties and the precautions to be taken when working with them.
It is intended for all personnel involved in the handling of acetone or DMF.
17 October 2019


Seagrasses of the genus Posidonia can form an irregular seascape due to erosional processes exposing thick walls of organic matter-rich soils. However, little is known about the location and characteristics of these particular formations. Here we provide comprehensive estimates of organic carbon (Corg) storage in P. oceanica and P. australis meadows, while providing insight into their location and mechanisms of formation, and highlighting future research directions. Erosional reef escarpments are restricted to shallow highly productive P. oceanica meadows from the Mediterranean Sea and P. australis meadows from the Indian Ocean, and sustain the existence of Corg-rich deposits in surrounding meadows. The thickness of the mat escarpments can reach up to 3 m and their length can vary from few to hundreds meters. Mechanisms of formation appear to differ among sites, from naturally-induced escarpments by wave action and/or tidal flow to human-induced escarpments by dredging activities. The inter-twined remains of seagrass shoots within the sediment matrix consolidate the sandy substrate and hold the exposed Posidonia mat escarpments together, maintaining a semi-rigid structure. This phenomenon is unusual but of exceptional importance in marine biogeochemical cycles, revealing the largest Corg sinks among seagrasses worldwide (ranging from 15-176 kg Corg m-2 in 2 m-thick mats accumulated at 2-249 g Corg m-2 yr-1 over 300 to 3000 yr).


The Department of Public Health and Social Services issued a guidance relative to the minimum requirements in celebration of Halloween.
DPHSS discourages traditional door-to-door trick-or-treating. Social gatherings of more than five individuals (i.e. Halloween and/or costume parties, haunted houses, etc.) are strictly prohibited.
The following guidelines are designed to minimize the risk of Covid-19 infection.
The DPHSS strongly encourages safe alternative activities to enjoying Halloween such as:
Decorating and carving pumpkins with only those in the same household;
Decorating your home;
Admiring Halloween decorations in your neighborhood at a distance;
Reading classic Halloween stories with those in the same household;
Baking Halloween-themed cookies;
Watching Halloween-themed movies or shows at your house;
Hiding Halloween treats in and around the house;
Participating in safe curbside trick-or-treating events sponsored by responsible businesses;
Holding drive-by costume or car-decorating contests with judges who are physically distanced; and/or
Holding a virtual Halloween costume contest so everyone can show off their costume.
In the event individuals choose to participate in traditional door-to-door trick-or-treating, DPHSS provides requirements below for all individuals involved.
General Guidance
Individuals experiencing flu-like symptoms or Covid-19-like symptoms are prohibited from participating in trick-or-treating.
Trick-or-treat only with members of the same household.
Face masks coverings must be worn by all individuals with the exception of children under the age of 2 or anyone who has difficulty breathing or a history of trouble breathing.
Households that have individuals under isolation or under quarantine due to Covid-19 are strictly prohibited from participating in any trick-or-treating activities.
All individuals participating in any trick-or-treating activities are advised to properly wash hands before and after each activity.
Consider household members who may be at greater risk of complications if Covid-19 is brought into the home, such as those with underlying health conditions, women who are pregnant, or older family members.
Guidance for Individuals/Households Distributing Treats
Wash hands properly before and after handling treats.
Wear a face mask at all times.
Avoid direct contact with other trick-or-treaters and maintain social distancing of 6 feet or more.
Treats should only be distributed outdoors.
Use store-bought treats that are individually plastic-wrapped.
Adults should be the individuals distributing treats while wearing a face mask and hand sanitizing between trick-or-treaters.
It is highly encouraged to practice safer, socially distant ways to conduct door-to-door trick-or-treating and distributing treats:
Set up a table/station outdoors with individually bagged treats spaced apart for trick-or-treaters to take.
Use a candy slide made of PVC pipe, or hanging treats from a wall or fence.
It is highly encouraged to use tongs, a spoon, or a tray to distribute treats. Children should not be allowed to retrieve their treats from a bowl or bag.
Covid-19 positive individuals or individuals in quarantine are strictly prohibited from distributing any treats.
Guidance for Parents/Guardians/Adults Responsible for Underage Trick-or-Treaters and for Trick-or-Treaters
Parents/Guardians should talk with their children about safety precautions and physical distancing in preparation of trick-or-treating.
If your child is at greater risk of complications from Covid-19, contact your doctor before allowing participation in Halloween activities.
Wear a face mask:
Highly encouraged to make face masks a part of Halloween costumes.
A costume mask is not a substitute for a face mask.
Do NOT wear a costume mask over a cloth mask or a cloth mask over a costume mask as it may make breathing more difficult.
Practice social distancing:
Stay at least 6 feet away from others who do not live in the same household
Individuals are more likely to get or spread Covid-19 when in close contact with others for a total of 15 minutes or more over a 24 hour period.
Wash your hands:
Bring hand sanitizer (with at least 60% alcohol) with you and use it after touching objects or other individuals.
Parents/Guardians: supervise young children using hand sanitizers.
Wash hands with soap and water for at least 20 seconds when you get home and before you consume any treats.
Upon completion of trick-or-treating, it is highly advised to:
Leave treats out for 48 hours before consuming.
Allow children to eat only original, factory-wrapped treats. Avoid homemade treats made by strangers.
Guidance for Business Operators Distributing Treats
It is highly discouraged for businesses to distribute treats in an enclosed or indoor area or in an in-person and non-curbside manner.
Outdoor, drive-up, and curbside is highly preferable during the distribution of treats.
All other DPHSS guidance memos and minimum requirements must be followed to include, but not be limited to:
Follow all occupancy requirements and limitations currently in effect.
Do not allow any congregation of individuals.
Have hand sanitizers readily available to all customers.
Eliminate all common seating, congregate, or play areas where children and others might gather.
Follow all other DPHSS guidance memos and minimum requirements currently in effect.


Here are a few notes on meditation:
-Your outlook during meditation should be positive and expectant but neutral. Don’t focus on or expect results. For example, in the Meditation on Twin Hearts, illumination rarely comes during a first session, though you begin accruing the benefits of greater energy and health immediately. Approach it as a climber approaches a mountain: He’s aware of the peak and expects to get there, yet he doesn’t focus on it. He looks only to the next handhold or foothold.
-Some people experience shaking or strong emotions welling up within them. As indicated earlier, meditation is an indirect clearing technique, and trembling or sudden feelings are evidence of energetic blockages being cleared out and the emotions associated with those blockages being released. If you encounter any discomfort during meditation, respond according to your personal threshold. Some people breathe more deeply and continue with the meditation. If you wish, however, you can stop the session and sweep and clean the area where you feel discomfort. You can meditate later.
-Both meditations should take about 20 minutes. In the Meditation on Twin Hearts, that includes about 10 minutes for blessing the earth and 10 minutes for illumination. As you gain experience, you may spend more time on the illumination portion.
-Beginners may experience slight congestion in the chest or heart area as they bless the earth during the Meditation on Twin Hearts. If this is uncomfortable, simply sweep and clean the area after you are finished. If it gets too uncomfortable, stop your meditation, and sweep and clean the area. You can meditate later or the next day.
-When you are able to hold simultaneous awareness on the point of light and the gap in the Meditation on Twin Hearts, you may experience an inner explosion of light. This is normal, though it can be startling at first. Again, respond according to your own personal comfort threshold. If you can, simply breathe deeply and feel the feeling of the experience. If you need to, stop meditating and close with giving thanks, then perform grounding.
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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.


A recent study published by the National Bureau of Economic Research (NBER) suggests that cryptocurrency markets move depending on the type of attention they receive – unlike traditional financial markets. In contrast with other traditional financial assets, cryptocurrencies don't behave or respond to the same set of market factors as traditional financial instruments but instead, move more closely with "cryptocurrency specific factors," according to the non-profit's report, which was published this week. These factors include investor attention and market momentum, described as the "time-series cryptocurrency momentum at the daily and weekly frequencies."
The paper's authors, Yale University economists Yukun Liu and Aleh Tsyvinski, suggest that, contrary to public opinion, "the markets do not view cryptocurrencies similarly to standard asset classes." The paper cited CoinDesk's bitcoin, ethereum and XRP price trackers (referring to XRP as "ripple") as the source of its market data. Using price data series over multi-year time frames, the paper compared actual returns to the projected returns using a standard finance pricing model known as the CAPM.
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Rabies is a deadly virus that damages the central nervous system of mammals. This zoonotic disease can spread to people and other animals, typically via bites from those already infected. Rabies often affects wildlife like raccoons, skunks, and bats, but it can easily affect domesticated cats and dogs.
Reports of cats with rabies exceed those in dogs, perhaps because more cats are allowed to roam free and may come into contact with rabid wildlife or stray animals.
After a cat has been exposed to rabies, it can take weeks to months for signs to appear. Once the signs of rabies appear in a cat, death usually occurs within about a week. There is no treatment for rabies in animals. This is why rabies vaccination is absolutely essential for all cats.
The signs of rabies in cats are typically seen in three stages: prodromal, excitative, and paralytic.
01 of 04 Bite Wound
Before signs of rabies appear, you may notice a bite wound or abscess on your cat. This might have come from wildlife, another cat, or even a dog, any of which may carry rabies.
Any bite wound or other injury should be treated by a veterinarian as soon as possible. Discuss your cat's rabies vaccination history with your vet so you can understand the risk of them contracting this disease.
If the cat has previously been vaccinated against rabies, your vet may recommend re-vaccination after the bite, especially if the vaccine is overdue. This can boost immunity and prevent rabies from infecting the cat.
If the cat has never been vaccinated for rabies, then there is no treatment available. These animals typically need to be quarantined and observed for signs of rabies. Sadly, humane euthanasia is the only option once signs of rabies begin.
The typical incubation period of rabies in cats lasts one to three months after exposure, but it may last longer in some cases. During this time, the virus travels through the body to the nervous system, eventually reaching the brain. The signs of rabies infection appear after this incubation period. Once signs of rabies appear, death typically occurs within about a week.
Note that cats may be able to spread rabies several days before signs appear.
02 of 04 Prodromal Stage
This is when the first signs of rabies affect the cat's behavior. You may notice that your outgoing cat is suddenly shy and hiding. Fearful cats might even become more confident. The cat may become lethargic and the appetite may decrease.
Behavior and personality changes vary by case; some cats will exhibit very noticeable personality changes as the virus takes its toll on the brain. Other cats will only show mild changes at first, making it difficult to make a definitive diagnosis.
The prodromal stage of rabies usually lasts two to three days.
03 of 04 Excitative Stage
During this second stage, cats tend to show more extreme behavior changes. They appear agitated and restless and often overreact to normal sights and sounds. Many cats will become aggressive for no apparent reason. They may attack people, other animals, and even objects without provocation.
The excitative stage can last one to seven days and may somewhat overlap the other stages.
04 of 04 Paralytic Stage
During the final stage of rabies, the cat develops weakness and eventually paralysis in the head, neck, and chest. The larynx will become paralyzed and the cat will no longer be able to vocalize or swallow. This is when the well-known sign of "foaming at the mouth" begins; if the cat is unable to swallow, salivation becomes excessive.
As weakness turns to paralysis, the muscles that control breathing can no longer function, leading to death.
The paralytic stage of rabies lasts two to four days and ultimately leads to death.
It's important to understand that each case of rabies is unique and the cat's signs may not match the typical signs described above.
Cats with known exposure to rabies or with any signs, even subtle ones, will need to be quarantined to protect people and other animals from exposure. Sick animals with suspected rabies will need to be euthanized.
If a cat with suspected rabies has bitten a person, that cat will need to be quarantined for ten days. This is because we know that death occurs soon after signs of rabies appear. If the cat does not die during the quarantine, then the bite could not have transmitted rabies to that person.
The only way to definitely diagnose rabies is through analysis of the brain tissue. After death, the brain must be sent to a pathologist for testing.


Abstract
Medication adherence is essential in preventing adverse intermediate outcomes, but little is known on hard outcomes. The aims of this study were to determine the 1-year adherence to oral antihyperglycemic drugs (OADs) and to predict the risk of subsequent health outcomes among (non)adherent patients with diabetes.Using a large Swiss healthcare claims database from 2011 to 2014, we identified all patients aged ≥18 years with diabetes and treated with at least 1 OAD prescription. Adherence to OADs was measured as the proportion of days covered (PDC) over 1 year and subdivided into 2 categories: adherent (PDC ≥ 80%), nonadherent (PDC < 80%). We estimated the relative risk of hospitalization and mortality at follow-up using multivariate Cox proportional hazard models.Based on a sample of 26,713 patients, adherence to OADs was quite low: 42% of the patients achieved a PDC of ≥80% during the 1-year observation period. A 7% reduction in the hospitalization risk and a 10% reduction in the risk of mortality could be observed in adherent patients compared to nonadherent patients (hazard ratio [HR], 0.93 [95% CI, 0.89-0.97]; HR, 0.90 [95% CI, 0.82-0.99]). Subgroup analysis showed that an intensified diabetes therapy had no significant influence on the risk of both outcomes in adherent patients.Poor medication adherence increases the risk of subsequent hospitalizations and premature mortality in patient with diabetes, regardless of disease severity and comorbidities. This emphasizes the need for an earlier identification of patients with poor medication adherence. The awareness of physicians and patients regarding the importance of adherence in diabetes treatment should be increased.


NCASE Resource Library Featured Resources
This publication features some of the best resources, including webinars, briefs, and toolkits, available in the online NCASE Resource Library, developed for both practitioners and system builders.
These selected resources, curated by NCASE, offer ideas and information for OST system leaders to support recovery from COVID-19.
The NCASE Out-of-School Time Professional Development System-Building Toolkit was designed to assist states as they build professional development systems inclusive of school-age providers.
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This webinar explores how leaders and stakeholders in WA developed a vision and conducted a 3-year pilot for creating an accessible, equitable, and high-quality system of programs for school-age and youth development. The webinar shares what was learned about professional development and coaching supports, and standards and assessment tools.
This webinar examines promising practices and research to support quality in Family Child Care (FCC). Dr. Juliet Bromer of Erikson Institute is featured as a special guest, presenting research on a conceptual quality model and strategies most likely to support providers in increasing quality.
This guide compares purpose, structure, content, and technical properties of assessment tools for out-of-school time programs.
This resource provides a review of tools that programs can use to measure youth outcomes. The outcomes selected include communication, relationships and collaboration, critical thinking and decision-making, initiative, and self-direction. The review includes cost and evidence of reliability and validity.
On October 5, 2016 the National Center on Afterschool and Summer Enrichment and the National Center on Early Childhood Quality Assurance came together to offer an interactive webinar session to help better understand the needs of States, Territories, and Tribes around supporting school-age children in family child care.
This chapter summarizes the trends in QRIS re-visioning among the 20 states that received Race to the Top-Early Learning Challenge (ELC) grants. The trends include a move toward promoting school readiness, continuous quality improvement, family engagement, and a focus on teaching and learning.
This executive summary reports on a three-year study of Youth Program Quality Improvement in 87 sites in four states that included quality assessment, improvement plans, coaching by managers, and staff training. The approach led to higher quality instructions across programs even where there was manager turnover, low staff education, and varying adult-youth ratios.
This webinar defines child care deserts and explores how two organizations have developed data-driven analyses to identify where there is persistent undersupply. The data demonstrate that lack of child care disproportionately impacts rural communities, low-income communities, and Latino and American Indian and Alaska Native families.
This report examines data from the National Survey of Early Care and Education. It aims to better understand home-based care and the 3.7 million paid and unpaid family child care providers in the U.S. Although the focus is on children aged birth to five years, it also includes tabulations on home-based providers serving school-aged children in Table B.


Abstract
The transcription factor KLF2 regulates T cell trafficking by promoting expression of the lipid-binding receptor S1P
1 and the selectin CD62L. Recently, it was proposed that KLF2 also represses the expression of chemokine receptors. We confirmed the upregulation of the chemokine receptor CXCR3 on KLF2-deficient T cells. However, we showed that this was a cell-nonautonomous effect, as revealed by CXCR3 upregulation on wild-type bystander cells in mixed bone-marrow chimeras with KLF2-deficient cells. Furthermore, KLF2-deficient T cells overproduced IL-4, leading to the upregulation of CXCR3 through an IL-4-receptor- and eomesodermin-dependent pathway. Consistent with the increased IL-4 production, we found high concentrations of serum IgE in mice with T cell-specific KLF2 deficiency. Our findings support a model where KLF2 regulates T cell trafficking by direct regulation of S1P 1 and CD62L and restrains spontaneous cytokine production in naive T cells. Bibliographical noteFunding Information:
The authors wish to thank Caitlin Dejong for preparing and shipping Eomes-deficient bones and Thirumalai Ramalingam and Thomas Wynn for providing IL-13R-deficient bones. Jerry Lingrel provided Klf2 fl mice. Jason Cyster provided reagents and assistance with anti-S1P 1 staining. Xiao Jie Ding and Jason Vevea provided excellent technical support. We thank Oludare Odumade and Amy Moran for helpful discussion and critical review of the manuscript. The authors declare no competing financial interests. This research was supported by NIH grants R01-AI39560 (to K.A.H.), R01-AI38903 (to S.C.J.), and T32-AI007313 (to M.A.W.).
Keywords CELLIMMUNO MOLIMMUNO


Study design
Ecological
Study population and setting
The study objective was to examine potential racial/ethnic disparities in deaths from COVID-19. Deaths were reported to the National Vital Statistics System from May 1 to August 31, 2020, across the US, including all states and Washington DC, and excluding residents of US territories or US citizens in foreign countries. Age of death, race/ethnicity, sex, region of residence (South, Northeast, Midwest, West) and place of death (e.g. such as healthcare setting, hospice, nursing home or long-term care facility) were also reported. Death due to COVID-19 was recorded if COVID-19 was an underlying cause of the chain of events leading to death (92% of COVID-19 deaths), or a contributing cause of death (8% of COVID-19 deaths). In total, 114,411 COVID-19-associated deaths were identified.
Summary of Main Findings
Out of 114,411 COVID-19 deaths during the study period, the highest number occurred in May 2020 (37,940, 33.2%). Overall, the majority of those decreased were male (53.3%, 60,961), White (51.3%, 58,692) and 65 years of older (78.2%, 89, 469). Additionally, 24.2% were Hispanic (N=27,687) and 18.7% were Black (N=21,394), which are greater proportions than their proportion of the general population by 5.5% and 6.0% respectively. Deaths among Hispanic people increased by 10.1 percentage-points over the study period, reaching roughly 25% of all COVID-19 deaths by August 2020. The plurality of average deaths across the study period occurred in the South (45.7%, 52,285), though in May the South represented just over 20% of deaths compared to August where it made up over 60%. For place of death, the majority died in an inpatient healthcare facility (64.3%, 73,566) followed by a nursing home or long-term care facility (22.0%, 25,170). From May to August, the proportion of deaths due to COVID-19 increased in the South, while it noticeably reduced in the Northeast. The percentage of deaths among people >=65 years remained relatively stable from May to August.
Study Strengths
Using data from the NVSS, the study was able to collect data on all deaths to identify and describe those in the US who died from COVID-19. They also had relatively detailed data, including many different categories for the place of death, and were able to show changes over time in the proportion of deaths between census regions and in racial/ethnic groups.
Limitations
The study did not have data on comorbid conditions or other contributing factors to death, which may have revealed further trends among racial/ethnic groups at increased risk for some of these conditions (such as diabetes, hypertension, etc.). The NVSS data may have delays in reporting, which would mean these numbers do not represent the deaths that occurred in these months, but only the reporting of deaths which may not track to real-time data. Additionally, the paper does not relate to deaths indirectly caused by the pandemic, such as individuals avoiding or delaying medical care. Another limitation was the dates of data available, from May through August 2020, which does not capture all deaths since the beginning of the pandemic.
Value added
This study examines death data from the entire US during the pandemic, highlighting important health disparities across racial/ethnic groups and geographic regions.
This review was posted on: 2 November 2020


The Virginia Transportation Research Council performed a laboratory investigation to evaluate whether stockpiling a CCPR mixture using foamed asphalt and cement as an active filler had any negative consequences with respect to the mechanical properties of the mixture. The mechanical properties included indirect tensile strength and dynamic modulus. The study recommended allowing stockpiling of CCPR mixtures using foamed asphalt and cement as the active filler for up to 24 hours. The study recommended verification of the findings and recommendations through follow-up studies.
Virginia Transportation Research Council Final Report No. FHWA/VTRC 19-R32, Virginia Department of Transportation, May 2019.


In its latest Office of the Future survey released by Canon, the findings reveals that all organizations surveyed across a range of verticals experienced a cyber threat over the past year.
Conducted by global tech market advisory firm ABI Research, the survey of more than one thousand U.S. IT professionals reveals three, pertinent cybersecurity threats, which are Malware and Ransomware, Compromised Devices, and Social Engineering.
Survey results include additional gaps, such as lack of appropriate cybersecurity spend across certain verticals; however, it also indicates hope, with nearly 25% of those surveyed stating that they are looking to increase investments in the key growth area of cloud security in the future.


ViiV’s HIV Drug, Tivicay, Launched in the UK
diagnosis Tivicay, Launched in the UK” src=”http://i57.tinypic.com/2re6t69.jpg” width=”164″ height=”147″ />HIV patients in the UK will from this week have another treatment option after ViiV Healthcare announced the launch of their once-daily drug, Tivicay (dolutegravir).
The integrase inhibitor was approved in Europe last month for HIV-1 in a broad patient population of treatment-naive and treatment-experienced adults and children aged 12 years and above (weighing at least 40kg) when used in combination with other antiretroviral agents.
The European regulatory approval was based on the results from four pivotal Phase III clinical trials where 2,557 adults received treatment with Tivicay or a comparator.
In one clinical study, called SINGLE, 88% of study participants on the Tivicay regimen were virologically suppressed versus 81% taking Atripla (efavirenz/emtricitabine/tenofovir) after 48 weeks’ treatment, and time to viral suppression was also reduced (28 days versus 84 days, respectively).
Tivicay blocks HIV replication by preventing viral DNA from integrating into the genetic material of human immune cells (T-cells), an essential step in the HIV replication cycle.
As Tivicay comes with the added convenience of once-daily dosing, and can be taken with or without food, in addition to being effective in both treatment-naive and treatment-experience patients, it is widely expected to become a key future player in HIV treatment.
Analysts have noted that Tivicay could generate annual sales of up to $2.1 billion by 2022 in the USA, Japan and five major EU markets of France, Germany, Italy, Spain and the UK, equating to 12.6% of the overall combined value of these markets.
However, Tivicay is currently only available through private prescription in England while a decision on NHS funding is made. The decision regarding the access of Tivicay on the NHS in England is expected between May and July this year.
Similarly, the SMC will appraise the drug in Scotland and the AWMSG in Wales, with decisions anticipated in May and June, respectively.


When divorced parents live far apart, it’s common for children to live full-time and attend school under the care and custody of just one parent. Long-distance parenting arrangements often include spending the summer with the non-custodial parent or alternating holidays. These arrangements may also make provisions for staying in touch with children remotely. This year, […]
Managing the divorce process is stressful, draining, and can be emotionally devastating. Divorce will affect every part of life and creates major upheaval of financial circumstances and living arrangements, contributing to instability and uncertainty. During such a volatile time when so much is at stake, the smartest move is to connect with a legal expert. […]
The beginning of a new school year is exciting. However, it also tends to create tension in custody arrangements since routines and schedules may shift. Parental custody is initially determined during the divorce proceedings, but over time it will be necessary to reevaluate the custody agreement to reflect life changes as your child grows up. […]
Divorce can be difficult for anyone to go through at any time… even more so during a global pandemic. If you and your spouse have recently decided to go separate ways, here are few tips on how to cope with divorce during an already difficult time. Use Technology to Lean on Family and Friends for Support The […]
The COVID-19 pandemic has thrown many families into uncertainty. This is especially true for families of divorce, who face co-parenting challenges and difficult daily decisions even when everything is normal. With new rules in place globally, it’s essential that you follow the rules set by federal government and local officials in order to keep your […]
Parental rights can be terminated in Arizona when such a move is best for the child’s safety and welfare. While Arizona courts prefer both parents to remain active in the child’s life, judges also understand that this is not always possible. It is essential to understand that once the termination of parental rights occurs, it […]
The holidays are supposed to be special, but for many families, they can be stressful and emotionally charged following a divorce. When parents are determining holiday visitation schedules, it is always best to put the interests and well-being of the child first. Doing so will go a long way toward ensuring that everyone has an opportunity […]
Can a parent who has sole legal custody/legal decision making deny visitation to their ex-spouse or ex-partner? It’s a sensitive topic and one that happens with significant regularity. The bottom line is that a parent with sole legal custody does not always have sole custody. In most cases, the courts grant joint physical parenting time to […]
Divorce creates significant ripples in your finances. These include the loss of a second income, the need to maintain a separate home, coupled with alimony and child support payments. It also involves the division of marital assets, including retirement accounts and pension plans. A family attorney in Arizona can help you protect these assets as […]
It may be possible to modify your spousal support obligations. While you can’t modify a non-modifiable agreement, it is possible to adjust a modifiable agreement. You can request a modification if there is a significant change in circumstances. For instance, if your ex-spouse remarries, if you suffer a severe financial setback, or if there are […]