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Purpose: Continuous lenalidomide maintenance treatment after autologous stem cell transplantation delivers improvement in progression free and overall survival among newly diagnosed multiple myeloma patients and has been the standard of care in the UK since March 2021. However, there is scant information about its impact on patients’ day-to-day lives. This service evaluation aimed to qualitatively assess patients receiving lenalidomide treatment at a cancer centre in London, in order that the service might better align with needs and expectations of patients. Methods: We conducted 20 semi-structured interviews among myeloma patients who were on continuous lenalidomide maintenance treatment at a specialist cancer centre in London. Members of the clinical team identified potentially eligible participants to take part, and convenience sampling was used to select 10 male and 10 female patients, median age of 58 (range, 45–71). The median treatment duration was 11 months (range, 1–60 months). Participants were qualitatively interviewed following the same semi-structured interview guide, which was designed to explore patient experience and insights of lenalidomide. Reflexive thematic analysis was used for data analysis. Results: Four overarching themes were as follows: (i) lenalidomide: understanding its role and rationale; (ii) reframing the loss of a treatment-free period to a return to normal life; (iii) the reality of being on lenalidomide: balancing hopes with hurdles; (iv) gratitude and grievances: exploring mixed perceptions of care and communication. Results will be used to enhance clinical services by tailoring communication to better meet patients’ preferences when making treatment decisions. Conclusion: This study highlights that most patients feel gratitude for being offered continuous lenalidomide and perceive it as alleviating some fears concerning relapse. It reveals variations in side effects in different age groups; younger patients reported no/negligible side effects, whilst several older patients with comorbidities described significant symptom burden, occasionally leading to treatment discontinuation which caused distress at the perceived loss of prolonged remission. Future research should prioritise understanding the unique needs of younger patients living with multiple myeloma. [ABSTRACT FROM AUTHOR]

Introduction: Triple therapy (fluticasone furoate/umeclidinium/vilanterol; FF/UMEC/VI) has been shown to improve symptoms and reduce exacerbations in patients with chronic obstructive pulmonary disease (COPD) and a history of exacerbations. This real-world study compared exacerbation rates and healthcare resource utilization (HCRU) before and after initiation of FF/UMEC/VI in patients with COPD previously treated with inhaled corticosteroid (ICS)/long-acting β2-agonist (LABA). Methods: This retrospective cohort study included commercial and Medicare Advantage with Part D administrative claims data from September 01, 2016, to March 31, 2020, of patients diagnosed with COPD. The index date was the date of the first FF/UMEC/VI claim (September 2017–March 2019). The 12 months prior to index (baseline) were used to assess patient characteristics and outcomes; the 12 months following index (follow-up) were used to assess study outcomes. All patients had ≥ 30 consecutive days' supply of any ICS/LABA dual therapy during the 12 months prior to FF/UMEC/VI initiation. Subgroup analyses included patients with ≥ 30 consecutive days' supply of budesonide/formoterol (BUD/FORM) during baseline. Analyses of patients with ≥ 1 COPD exacerbation during baseline were reported as well. Results: The overall population included 1449 patients (mean age 70.75 years; 54.18% female), of whom 540 were patients in the BUD/FORM subgroup. Significantly fewer patients experienced any exacerbation during follow-up versus baseline (overall population 53.49% vs 62.59%; p < 0.001; BUD/FORM subgroup 55.00% vs 62.41%; p = 0.004). Effects on exacerbation reduction were more pronounced among patients with ≥ 1 exacerbation during baseline. Lower COPD-related HCRU was observed during the follow-up compared with baseline for both the overall population and the BUD/FORM subgroup. Conclusion: Patients with COPD treated with ICS/LABA during baseline, including patients specifically treated with BUD/FORM and those with a history of ≥ 1 exacerbation, had fewer COPD exacerbations and lower COPD-related HCRU after initiating FF/UMEC/VI. [ABSTRACT FROM AUTHOR]

High dose melphalan (HDM) followed by autologous stem cell transplantation (ASCT) remains the standard consolidation in transplant eligible multiple myeloma (MM) patients. The timing between HDM administration and hematopoietic stem cell return (HSCR) varies among institutions, with a 'rest period' of 48 hours (h) employed by some for patients with renal impairment (RI). We investigated the differences in hematopoietic recovery and HDM toxicity between MM patients with RI who had HSCR after 24 vs 48 h from HDM. Fifty MM patients with RI (48 h group; n = 31 and 24 h group; n = 19) were included. No statistically significant differences were noted in surrogates for hematopoietic recovery and HDM toxicity between both groups. Only one death occurred in the 24 h group. No patients required renal replacement therapy. Therefore, a 24 h period between HDM and AHSC infusion appears safe for MM patients with RI. [ABSTRACT FROM AUTHOR]

Fred Balda, president of Hillwood Communities-the residential development division of Dallas-based Hillwood-made a quick decision that was emblematic of his leadership style. Balda and Mastrocola were among White's first hires to work on the residential component. For 18 years, Balda and his wife, Cindy, lived in Estates of Russell Creek, a Hillwood community in Plano, Texas, and raised their three sons. [Extracted from the article]

Three additional patients without prior COVID-19 infection also achieved titers >2500 U/mL at 22 days [6-39] post re-vaccination, compared to titers of 32.7 U/mL (IQR 28.8-36.4) in the same group post-ASCT, demonstrating ability to mount substantial antibody response in the post-ASCT setting. Three patients unexpectedly demonstrated evolving response post-ASCT (pre-ASCT serology measured 26 days [18-36] post-vaccine, time from first vaccine to ASCT 68, 82 and 102 days respectively) which may reflect that humoral response can take several weeks to reach maximum antibody response. Our data suggest that patients who have been vaccinated against COVID-19 prior to ASCT maintain anti-SARS-CoV-2 titers in the immediate post-ASCT setting - a time when patients are considered most vulnerable to infection, and prior to them being offered re-vaccination. [Extracted from the article]

Autologous stem cell transplantation (ASCT) is standard of care in biologically fit, newly diagnosed multiple myeloma (MM) patients, offering better therapeutic outcomes and improved quality of life (QoL). However, with the UK's 1st national lockdown on 23/03/2020, several guidelines recommended deferring ASCT due to risks of infection, with resource limitations forcing some units to suspend ASCT entirely. Such changes to patients' treatment plans inevitably altered their lived experience during these uncertain times with expected impact on QoL. We conducted a qualitative study using semi-structured interviews to gain insight into MM patients' understanding of their disease, initial therapy and ASCT, and their response to therapy changes. A clinical snapshot of how COVID-19 affected the MM ASCT service in a single UK institution is also provided, including changes to chemotherapy treatment plans, timing, and prioritisation of ASCT. Framework analysis identified 6 overarching themes: (1) beliefs about ASCT, (2) perceptions of information provided about MM and ASCT, (3) high levels of fear and anxiety due to COVID-19, (4) feelings about ASCT disruption or delay due to COVID-19, (5) perceptions of care, and (6) importance of social support. Example subthemes were beliefs that ASCT would provide a long-remission/best chance of normality including freedom from chemotherapy and associated side-effects, disappointment, and devastation at COVID-related treatment delays (despite high anxiety about infection) and exceptionally high levels of trust in the transplant team. Such insights will help us adjust our service and counselling approaches to be more in tune with patients' priorities and expectations. [ABSTRACT FROM AUTHOR]

Mobile-based ecological momentary assessment (mEMA) offers a novel method for dietary assessment and may reduce recall bias and participant burden. This review evaluated mEMA methodology and the feasibility, acceptability and validity as a dietary assessment method in young people. Five databases were searched from January 2008 to September 2021 for studies including healthy young people aged 16–30 years and used mEMA for obtaining dietary intake data, food consumption behaviours and/or contextual factors. Data on the method used to administer mEMA, compliance with recording and validation were extracted. A total of 46 articles from 39 independent studies were included, demonstrating a wide variation in mEMA methods. Signal-contingent prompting (timed notification to record throughout the day) was used in 26 studies, 9 used event-contingent (food consumption triggered recordings), while 4 used both. Monitoring periods varied and most studies reported a compliance rate of 80% or more. Two studies found mEMA to be burdensome and six reported mEMA as easy to use. Most studies (31/39) reported using previously validated questions. mEMA appears to be a feasible and acceptable methodology to assess dietary intake and food consumption in near real time. [ABSTRACT FROM AUTHOR]

The ontogeny of human haematopoietic stem cells (HSCs) is poorly defined owing to the inability to identify HSCs as they emerge and mature at different haematopoietic sites1. Here we created a single-cell transcriptome map of human haematopoietic tissues from the first trimester to birth and found that the HSC signature RUNX1+HOXA9+MLLT3+MECOM+HLF+SPINK2+ distinguishes HSCs from progenitors throughout gestation. In addition to the aorta–gonad–mesonephros region, nascent HSCs populated the placenta and yolk sac before colonizing the liver at 6 weeks. A comparison of HSCs at different maturation stages revealed the establishment of HSC transcription factor machinery after the emergence of HSCs, whereas their surface phenotype evolved throughout development. The HSC transition to the liver marked a molecular shift evidenced by suppression of surface antigens reflecting nascent HSC identity, and acquisition of the HSC maturity markers CD133 (encoded by PROM1) and HLA-DR. HSC origin was tracked to ALDH1A1+KCNK17+ haemogenic endothelial cells, which arose from an IL33+ALDH1A1+ arterial endothelial subset termed pre-haemogenic endothelial cells. Using spatial transcriptomics and immunofluorescence, we visualized this process in ventrally located intra-aortic haematopoietic clusters. The in vivo map of human HSC ontogeny validated the generation of aorta–gonad–mesonephros-like definitive haematopoietic stem and progenitor cells from human pluripotent stem cells, and serves as a guide to improve their maturation to functional HSCs.The HSC signature RUNX1+HOXA9+MLLT3+MECOM+HLF+SPINK2+ distinguishes haematopoietic stem cells from their endothelial precursors and differentiated progenitors throughout ontogeny [ABSTRACT FROM AUTHOR]

A total of 41 (89%) patients started anti-myeloma therapy, three declined, two had not yet commenced treatment; 20 (49%) proceeded to autologous stem cell transplantation (Table SIV). Patients progressing at <6 months from diagnosis were excluded as these patients likely represent evolving disease; similarly those with <6 months of follow-up were also excluded. Smouldering myeloma (SMM) is an asymptomatic stage of multiple myeloma with bone marrow plasma cells >10% or paraprotein >30 g/l, forming a heterogenous group of patients, with variable progression to active myeloma.1 The SMM standard of care is surveillance to identify early progression. [Extracted from the article]

Prophylactic strategies (e.g. anti-spike monoclonal antibodies) in patients identified at high-risk of vaccine response failure or in whom vaccination response is suboptimal should be explored. (B) Comparison of post second dose antibody titres in patients who only seroconverted after second dose (n = 19) versus patients with positive response after one dose (n = 69); median (IQR) 54-8 (10-9-299) u/ml versus 1593 (506-2500) u/ml, P < 0-0001. 4 ** There is a borderline association between presence of a post-dose 1 response and response post-dose 2 ( I P i = 0-05), with patients with missing dose 1 responses being more likely to respond post-dose 2. Keywords: multiple myeloma; severe acute respiratory syndrome coronavirus-2; vaccination response; plasma cell disorders; humoral response EN multiple myeloma severe acute respiratory syndrome coronavirus-2 vaccination response plasma cell disorders humoral response e21 e26 6 01/28/22 20220201 NES 220201 We read with interest Avivi I et al i .1 evaluating humoral response to two doses of BNT162b2 mRNA vaccine in multiple myeloma (MM) at manufacturer's dosing interval. [Extracted from the article]

Exposure to pesticides in humans increases the risk of Parkinson’s disease (PD), but the mechanisms remain poorly understood. To elucidate these pathways, we dosed C57BL/6J mice with a combination of the pesticides maneb and paraquat. Behavioral analysis revealed motor deficits consistent with PD. Single-cell RNA sequencing of substantia nigra pars compacta revealed both celltype-specific genes and genes expressed differentially between pesticide and control, including Fam241b, Emx2os, Bivm, Gm1439, Prdm15, and Rai2. Neurons had the largest number of significant differentially expressed genes, but comparable numbers were found in astrocytes and less so in oligodendrocytes. In addition, network analysis revealed enrichment in functions related to the extracellular matrix. These findings emphasize the importance of support cells in pesticide-induced PD and refocus our attention away from neurons as the sole agent of this disorder. [ABSTRACT FROM AUTHOR]

Upfront autologous stem cell transplant (ASCT) for transplant-eligible patients with newly diagnosed multiple myeloma (MM) remains standard of care [[1]]. American society of blood and marrow transplantation, European society of blood and marrow transplantation, blood and marrow transplant clinical trials network, and international myeloma working group consensus conference on salvage hematopoietic cell Transplantation in Patients with Relapsed Multiple Myeloma. Overall, 23 patients (39%) received consolidation and/or maintenance regimens post-ASCT2, a factor shown to improve 2nd PFS in other studies of ASCT2(10,11). [Extracted from the article]

Development of antibody response to SARS-CoV-2 following asymptomatic infection in patients with plasma cell disorders on immunomodulatory therapy Keywords: antibody response; COVID-19 disease; multiple myeloma; plasma cell disorders; SARS-CoV-2 EN antibody response COVID-19 disease multiple myeloma plasma cell disorders SARS-CoV-2 857 861 5 09/02/21 20210901 NES 210901 Patients with multiple myeloma and related plasma cell disorders (PCD) are considered extremely vulnerable to SARS-CoV-2 infection due to disease-related impaired humoral and cellular immunity as well as receipt of immunosuppressive therapy.1 Overall mortality from COVID-19 disease in 650 PCD patients across 10 countries was 33%.2 Poor outcomes from COVID-19 disease have resulted in recommendations for modifications to systemic anti-cancer therapy (SACT) to reduce the risk of infection whilst balancing the potential complications of untreated PCD.3 With the rollout of the COVID-19 vaccines, there is urgent need to understand seroconversion in immunocompromised patients for ongoing patient management and recommendation. Positive antibody test post PCR-confirmed infection occurred at a median of 86-5 days compared to 30-5 days for those who tested negative, suggesting a delayed response compared to the general population of 14-28 days.12 Our study and analyses are limited by small number of seropositive patients and those undergoing antibody testing post PCR-diagnosed COVID-19 disease. Patients with positive SARS-CoV-2 antibody test categorised by PCR-positive patients and unexpected antibody test positive patients. [Extracted from the article]

Background: The treatment paradigm for multiple myeloma (MM) continues to evolve with the development of novel therapies and the earlier adoption of continuous treatments into the treatment pathway. Lenalidomide-refractory patients now represent a challenge with inferior progression free survival (PFS) reported to subsequent treatments. We therefore sought to describe the natural history of MM patients following lenalidomide in the real world. Methods: This was a retrospective cohort review of patients with relapsed MM who received lenalidomide-based treatments in the U.K. Data were collected for demographics, subsequent therapies, treatment responses, survival outcomes and clinical trial enrollment. Results: 198 patients received lenalidomide-based treatments at a median of 2 prior lines of therapy at a median of 41 months (range 0.5-210) from diagnosis. 114 patients (72% of 158 evaluable) became refractory to lenalidomide. The overall survival (OS) after lenalidomide failure was 14.7 months having received between 0-6 subsequent lines of therapy. Few deep responses were observed with subsequent treatments and the PFS to each further line was < 7 months. There was a steep reduction in numbers of patients able to receive further treatment, with an associated increase in number of deaths. The OS of patients progressing on lenalidomide who did not enter a clinical trial incorporating novel agents was very poor (8.8 months versus 30 months, p 0.0002), although the trials group were a biologically fitter group. Conclusion: These data demonstrate the poor outcomes of patients failing lenalidomide-based treatments in the real world, the highlight need for more effective treatments. [ABSTRACT FROM AUTHOR]

In this article, a section of the Alpha-Text Esther story (1:10–15) is brought to the foreground to reveal the hitherto unrecognized hints that point to the Hebrew Vorlage , the literary Tendenz , and the scribal negligence unparalleled in either the Septuagint or the Masoretic text. All these literary phenomena suggest that the Alpha-Text and the Masoretic text versions reflect two variant archetypes of a Hebrew text, but this does not mean that both archetypes cannot overlap at places. When the archetypes do overlap, some of the unique readings in the Alpha-Text actually reflect later exegeses or misunderstandings that are dependent on the readings preserved in both the Masoretic text and the Septuagint. The later exegeses in particular help locate the Sitz im Leben of Alpha-Text Esth 1:10–15 in the Hasmonean period and thereafter when the Jewish-gentile relationship is strained. [ABSTRACT FROM AUTHOR]

"Ed and his team have developed some of the most sought-after residential and mixed-use communities in the Southeast", says Rick Beckwitt, co-CEO and president of Lennar, who nominated Burr for the Hearthstone award. In addition to his involvement with MBF, Burr also has put his energy and resources into several other community organizations. The MBF programs cover four types of child abuse-neglect, emotional abuse, physical abuse, and sexual abuse-in an age-appropriate way. [Extracted from the article]

The benefit of autologous stem cell transplantation (ASCT) in newly diagnosed myeloma patients, apart from supporting high dose chemotherapy, may include effects on T cell function in the bone marrow (BM). We report our exploratory findings on marrow infiltrating T cells early post-ASCT (day+100), examining phenotype and T cell receptor (TCR) repertoire, seeking correlations with timing of relapse. Compared to healthy donors (HD), we observed an increase in regulatory T cells (CD4+FoxP3+, Tregs) with reduction in CD4 T cells, leading to lower CD4:8 ratios. Compared to paired pre-treatment marrow, both CD4 and CD8 compartments showed a reduction in naïve, and increase in effector memory subsets, suggestive of a more differentiated phenotype. This was supported by increased levels of several immune-regulatory and activation proteins (ICOS, PD-1, LAG-3, CTLA-4 and GzmB) when compared with HD. Unsupervised analysis identified a patient subgroup with shorter PFS (p=0.031) whose BM contained increased Tregs, and higher immune-regulatory markers (ICOS, PD-1, LAG-3) on effector T cells. Using single feature analysis, higher frequencies of marrow PD-1+ on CD4+FoxP3- cells and Ki67+ on CD8 cells were independently associated with early relapse. Finally, studying paired pre-treatment and post-ASCT BM (n=5), we note reduced abundance of TCR sequences at day+100, with a greater proportion of expanded sequences indicating a more focused persistent TCR repertoire. Our findings indicate that, following induction chemotherapy and ASCT, marrow T cells demonstrate increased activation and differentiation, with TCR repertoire focusing. Pending confirmation in larger series, higher levels of immune-regulatory proteins on T cell effectors at day+100 may indicate early relapse. [ABSTRACT FROM AUTHOR]

Between 2010 and 2019, 63 MM patients received DT-PACE/ESHAP containing regimens: 42 (67%) for primary refractory, and 21 (33%) for relapsed disease including five patients who had previously received ASCT. One series reports that those able to receive ASCT fared better, suggesting that these patients still benefit from ASCT.12 Our data show a clear distinction in outcomes between patients who were consolidated with ASCT post DT-PACE/ESHAP (mostly primary refractory), I versus i the rest. This is the largest UK dataset of MM patients treated with DT-PACE/ESHAP reported to date, and confirms that even with current novel therapy, traditional infusional regimens retain a role in patients with high risk disease and are well tolerated. Chemotherapy regimens used for induction therapy [all patients and primary refractory patients proceeding to autologous stem cell transplant (ASCT) post ESHAP/PACE].Table SII. [Extracted from the article]

Objective  This study aimed to describe two cases of acute respiratory distress syndrome (ARDS) secondary to novel coronavirus disease 2019 (COVID-19) in pregnant women requiring extracorporeal membrane oxygenation (ECMO), and resulting in premature delivery. Study Design  The clinical course of two women hospitalized with ARDS due to COVID-19 care in our intensive care (ICU) is summarized; both participants provided consent to be included in this case series. Results  Both women recovered with no clinical sequelae. Neonatal outcomes were within the realm of expected for prematurity with the exception of coagulopathy. There was no vertical transmission to the neonates. Conclusion  This case series highlights that ECMO is a feasible treatment in the pregnant woman with severe COVID-19 and that delivery can be performed safely on ECMO with no additional risk to the fetus. While ECMO carries its natural risks, it should be considered a viable option during pregnancy and the postpartum period. Key Points COVID-19 may present with a more severe course in pregnancy. ECMO may be used in pregnant woman with severe COVID-19. Delivery can be performed on ECMO without added fetal risk. [ABSTRACT FROM AUTHOR]

Haddad and Jeffrey Roos (who now leads Lennar's home building business in California) decided to keep the company together, selling its one unencumbered property for $3 million while they looked for new investors. "We've been involved in these communities for 15, 20, 25 years, and Emile is always looking past to where we were headed and not letting these incremental things detract or distract us", says Lynn Jochim, chief operating officer of FivePoint, who has worked with Haddad since 1999. The CEO of Irvine, California-based FivePoint Holdings, if he became a developer because he had seen so much destruction in his hometown of Beirut. [Extracted from the article]

COMPANY: GREAT SOUTHERN HOMES LOCATION: SOUTH CAROLINA "GENEROUS", "SUPPORTIVE", AND "SELFLESS" are just a few of the recurring words that were used to describe the character of Great Southern Homes' Michael Nieri. In 2019, the builder ranked No. 54 on the Builder 100 with 947 closings; the firm has jumped to No. 44 for 2020 (see p. 57). -Michael Nieri' Clemson University THIS PAST YEAR, NIERI AND HIS WIFE, ROBYN, chose to gift $5 million to Clemson University's Construction Science and Management Department. "Michael has always been a charitable type of person, but 20 years ago, Michael couldn't have made the contribution that he's making to Camp Cole today", says Mike Satterfield, CEO at Great Southern Homes. [Extracted from the article]

Community health workers (CHWs) have been effectively utilised in resource‐limited settings to combat a growing demand for health access that cannot be met by the current workforce. The purpose of this study was to evaluate a CHW training programme in Malawi that integrated technology into rehabilitation care delivery. This was a retrospective cross‐sectional study of a training programme conducted in December 2018. The participants were a convenience sample of all active home‐based palliative care CHWs at St. Gabriel's Hospital (n = 60). The data collected included the following: a written pre‐ and post‐knowledge test, skills competency checklist and a post‐training programme survey. Descriptive frequencies described skill competency and quantitative responses from the post‐training programme survey. Paired t test (α = 0.05) analysis determined the significance of knowledge acquisition. Themes in the narrative responses in the post‐training survey were identified. Both training programme groups showed significantly greater knowledge on the post‐test (M = 9.50, SD = 0.861; M = 9.43, SD = 0.971) compared to the pre‐test (M = 7.97, SD = 1.351; M = 7.90, SD = 1.900); t(29) = 6.565, p <.001; t(29) = 4.104, p <.001 for Group 1 and Group 2, respectively. All participants demonstrated skill competency in 100% of the skills. All participants responded that the training programme helped them review skills and understand how to use technology 'A lot' on a Likert scale (no, a little, some, a lot). Facilitators of their work included training programmes, phones, communication with the hospital and collaboration amongst CHWs. Barriers included transportation needs, lack of patient care supplies and lack of caregiver compliance. Overall, utilisation of their knowledge and skills from the training programmes helped their patients make improvements in mobility and function that are meaningful to their quality of life in the village. This study highlights the importance of assessing programmes in low‐resource settings with a focus on feasibility and developing local capacity. [ABSTRACT FROM AUTHOR]

The present article seeks to describe, analyze, and evaluate the modern scholarly attempts to grapple with the moral issues about good and evil in the Hebrew Esther story. The first part of the article examines the anti-Semitic sentiments looming behind the pre-World War II European, especially the Protestant, commentators' ethics assessments of the book of Esther and its Jewish characters, before pointing out a blind spot in these assessments. The second part of the article offers a systematic analysis of the gradual change of attitude induced mainly by the Jewish scholars in the aftermath of the Second World War. Lastly, the paper turns the spotlight on the Esther studies conducted by recent feminist and other marginalized biblical scholars. Attempts are made to demonstrate how their works, coming from different social contexts, enrich the academic discussions about good and evil in the book of Esther. [ABSTRACT FROM AUTHOR]

An early entrant was Brizo's contemporary Vuelo faucet; new to the market is Rohl's Graceline pull-down kitchen faucet in matte black, which has a gold handle and spout. PUTTING ON THE RITZ White is still the predominant color in the kitchen, according to Houzz's 2020 survey of kitchen trends. Kohler has since chimed in with its recently announced Tailor farmhouse sink, which has an apron that can be customized with user-supplied materials in addition to Kohler's inserts. According to the Houzz kitchen survey, 40% of new or remodeled kitchen islands are in a contrasting color (45% are gray or blue, while 11% are black). [Extracted from the article]

Adolescent idiopathic scoliosis affects 1% to 3% of U.S. adolescents. It is defined by a lateral curvature of the spine (Cobb angle) of at least 10 degrees in the absence of underlying congenital or neuromuscular abnormalities. Adolescent idiopathic scoliosis may be detected via the forward bend test and should be confirmed with scoliometer measurement. Mild scoliosis is usually asymptomatic; it may contribute to musculoskeletal back pain, but there is no evidence that it causes disability or functional impairment. Patients with severe scoliosis (Cobb angle of 40 degrees or more) may have physical pain, cosmetic deformity, psychosocial distress, or, rarely, pulmonary disorders. Several studies have shown modest benefit from bracing and scoliosis-specific physical therapy to limit progression in mild to moderate scoliosis, but there were no effects on quality of life. Because no high-quality studies have proven that surgery is superior to bracing or observation, it should be reserved for severe cases. There is little evidence that treatments improve patient-oriented outcomes. The U.S. Preventive Services Task Force and the American Academy of Family Physicians found insufficient evidence to assess the balance of benefits and harms of screening for adolescent idiopathic scoliosis in children and adolescents 10 to 18 years of age. [ABSTRACT FROM AUTHOR]

Limited knowledge of the mechanisms that govern the self-renewal of human haematopoietic stem cells (HSCs), and why this fails in culture, have impeded the expansion of HSCs for transplantation1. Here we identify MLLT3 (also known as AF9) as a crucial regulator of HSCs that is highly enriched in human fetal, neonatal and adult HSCs, but downregulated in culture. Depletion of MLLT3 prevented the maintenance of transplantable human haematopoietic stem or progenitor cells (HSPCs) in culture, whereas stabilizing MLLT3 expression in culture enabled more than 12-fold expansion of transplantable HSCs that provided balanced multilineage reconstitution in primary and secondary mouse recipients. Similar to endogenous MLLT3, overexpressed MLLT3 localized to active promoters in HSPCs, sustained levels of H3K79me2 and protected the HSC transcriptional program in culture. MLLT3 thus acts as HSC maintenance factor that links histone reader and modifying activities to modulate HSC gene expression, and may provide a promising approach to expand HSCs for transplantation. MLLT3 is identified as a crucial regulator of the self-renewal of human haematopoietic stem cells, and helps to maintain an active chromatin state in haematopoietic stem-cell regulatory genes during culture. [ABSTRACT FROM AUTHOR]

Salt Lake City-based Garbett Homes, which he founded after graduating from the University of Utah, is one of the state's largest and most innovative home builders, with more than 5,000 homes and apartments in 30 communities sprinkled along the Wasatch Front. Green building and healthy homes are slowly catching on in Utah, Garbett says, but his firm is still the only production builder in the state that provides HERS scores on every home it sells. GARBETT TOOK A GOOD, HARD LOOK AT WHAT HIS COMPANY COULD OFFER THAT NO ONE ELSE COULD-AND MODERN, comfortable, SUSTAINABLE HOMES WAS THE ANSWER. [Extracted from the article]

WHEN NICK BLUE OF BLUE SKY HOMES, A BUILDER and developer in Phoenix, decided to focus on "future-proofing" his company's homes and increasing their energy efficiency, his first step was to get a HERS (Home Energy Rating System) score. Today, nearly one out of every four new homes built in the U.S. is HERS rated, and the homes are produced by both small custom builders and large production builders, including major names like Lennar, KB Home, and Pulte. Custom home builder Tony Fiore, who started to test passive solar construction in the 1970s, wanted to create a model home that would be the culmination of his experience in energy-efficient building. Many home appraisers are not trained in how to do this, and mortgage bankers aren't always aware of or willing to offer government-sponsored energy-efficient mortgage products, thus putting the onus on the builder to educate the buyer. [Extracted from the article]

According to UPL, an Ohio natural gas utility company, area homes equipped with natural gas see a 5% to 10% increase in their resale value compared with similar homes sans gas. Electric furnaces, which send a current through coils to generate heat-also known as electric resistance heating-are a comparatively inefficient and expensive way to create heat. Electric heat pumps, on the other hand, are much more efficient at heating than both electric resistance and gas alike, but the advanced technology also has a higher up-front cost and is likely to still be more expensive to operate than gas. Direct-vent gas inserts, which are sealed off from the room and have a venting system that draws and exhausts air directly to the exterior, are more efficient for heating than open-hearth gas fireplaces. [Extracted from the article]