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Trends That Will Transform Asthma Care in 2022

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In 2022 and beyond, the care of patients with asthma will likely be transformed by novel monoclonal antibodies targeting cytokines, new asthma guidelines emphasizing precision medicine, and real-world evidence on the efficacy of newer asthma drugs. These were among the predictions made by Jon Romeo, DO, chair of the American College of Allergy, Asthma and Immunology Asthma Committee. In an interview with Pulmonology AdvisorDr Romeo, an allergy and immunology specialist in Raleigh, North Carolina, offered his views on what’s ahead in 2022 as well as the most important developments in asthma care during the past year.

In 2021, research on monoclonal antibodies took center stage, said Dr Romeo. Especially notable were several landmark studies on the monoclonal antibodies tezepelumab and astegolimab, both of which showed impressive efficacy in reducing asthma exacerbation rates.1,2 A few weeks before the end of 2021 ended, this research finally bore fruit when Tezspire, a tezepelumab-based pharmacologic agent (tezepelumab-ekko), received Food and Drug Administration approval.3-5

“I think those 2 drugs [tezepelumab and astegolimab] are fascinating and are going to be really helpful as being additional treatment options for patients with severe asthma,” said Dr Romeo. “We have a number of biologics already approved for severe, persistent asthma, all monoclonal antibodies directed at asthma, all of them directed at T2 asthma,” he noted. “But the drugs we currently have on the market really only treat certain subsets of people with severe asthma, either those with high eosinophil levels or those that have an allergic phenotype to their asthma.” This means that the asthma treatments that have been available thus far “don’t really work that well” for a significant subset of people with asthma, he explained.


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“The most interesting thing about these 2 [new] drugs,” he continued, “is that they are focused on a different aspect, the cytokines, released from the respiratory epithelium, and they did show effectiveness in all comers with severe asthma regardless of their T2 status.”

Tezepelumab is a first-in-class human monoclonal antibody that works by blocking thymic stromal lymphopoietin, an epithelial cytokine involved in the initiation and persistence of airway inflammation.3-5 Astegolimab, a human immunoglobin G2 monoclonal antibody, selectively inhibits the interleukin-33 receptor, ST2, and in doing so may target pathogenic pathways in a wider spectrum of asthmatics.2

The FDA’s recent approval of Tezspire should change asthma care in the year ahead, he stressed. Tezspire, a monoclonal antibody used as an add-on maintenance treatment for patients 12 years of age and older with severe asthma, is administered subcutaneously to patients by a health care provider once every 4 weeks.3-5 “I think it’s going to be a real game-changer for those people who have not responded to the agents that we’ve had on the market the last couple of years.”

FDA approval of Tezspire followed the phase 3 NAVIGATOR trial (ClinicalTrials.gov Identifier: NCT03347279), the results of which were reported this spring in the New England Journal of Medicine.1 In that trial, investigators found that participants receiving tezepelumab had approximately 50 percent fewer asthma exacerbations relative to placebo. The trial included 1059 participants who were 12 to 80 years old (528 who received tezepelumab and 531 who received placebo) with severe uncontrolled asthma and a wide range of blood eosinophil counts. Participants received tezepelumab or placebo subcutaneously every 4 weeks for 52 weeks while they continued their previously prescribed inhaled glucocorticoids and additional controller medications. The trial found that individuals receiving tezepelumab showed improvement in asthma control as well as better asthma-related quality of life and lung function with tezepelumab.1

Findings of a phase 2b clinical trial of astegolimab (ClinicalTrials.gov Identifier: NCT02918019) was published in the Journal of Allergy and Clinical Immunology in April.2 The trial found that astegolimb reduced adjusted asthma exacerbation rates relative to placebo by 43%. In the multicenter randomized trial in 15 countries, 502 adults with poorly controlled severe asthma, 18 to 75 years old, were subcutaneously administered 1 of 3 doses of astegolimab or placebo every 4 weeks for a year. A broad population of patients saw improvement, including those who were eosinophil-low.2

Astegolimab has yet to complete phase 3 trials. “I’m guessing that’s not something that’s going to be available in the next 6 to 8 months, maybe not even the next 12 months, depending on what the studies show and then how long it takes to get approved through the FDA,” he said. Dr Romeo. “But I love that there is another drug in development directed at one of these cytokines.”

Both tezepelumab and astegolimab “fit into the broader shift towards our understanding of the bronchial epithelium,” noted Dr Romeo. “We used to focus a bit more downstream, a little further along in the inflammatory cascade, at some of these later proteins that get developed that drive the inflammation in asthma. We are gaining a greater understanding of how important the respiratory epithelium is in creating the inflammation in asthma.”

Beyond these novel monoclonal antibodies, another major development in the management of asthma during the past year was the revision of the Global Initiative for Asthma guidelines,6 which came on the heels of the 2020 update of the National Asthma Education and Prevention Program guidelines.7 These updates had been long-awaited, said Dr Romeo.

One of the “more dramatic shifts we’ve seen in recommendations as far as managing asthma” in these guidelines is a push “to get away from using albuterol as a rescue medication and instead to consider using a low-dose inhaled steroid combined with formoterol ,” said Dr Romeo. “Data has come out over the last few years that showed that by using these combo products of inhaled steroids with a long-acting beta-agonist, we were actually able to achieve a similar level of asthma control, or sometimes even superior asthma control, and it helps in preventing people from overusing their rescue inhalers as a kind of maintenance. Now you can actually use the same inhaler for both maintenance and rescue, adjusting the frequency and sometimes the dosage of the medication based on symptoms.”

Another consequential development in asthma care evident in the new asthma guidelines is an emphasis on developing a precision medicine approach to asthma control. Instead of “having blanket recommendations for all people with asthma,” clinicians are being encouraged to “more precisely treat the individual,” said Dr Romeo.

“There’s a lot of research going on right now,” he added. “The consortium PrecISE [Precision Interventions for Severe and/or Exacerbation-Prone Asthma Network] (ClinicalTrials.gov Identifier: NCT04129931) is enrolling a lot of patients and trying to learn about different biomarkers that identify people with certain subtypes of asthma to do more targeted therapy for the individual.8 There’s a big push in medicine in general, but certainly in asthma, to start to home in on biomarkers that tell us what’s driving asthma from a genetic or environmental standpoint and then, over time, that will allow us to devise treatments that will more individually treat patients.”

Dr Romeo also foresees that some of the newer asthma drugs could be utilized in younger populations of patients. “For some [of these drugs]like omalizumab,9 which is Xolair, and benralizumab,10 which is Fasenra, they’ve done real-world studies, where they actually see how effective the medication is, retrospectively looking at people who were put on the drug and not in any kind of clinical trial setting,” he explained. The studies have confirmed “that these drugs do continue to work even if it’s not perfect conditions. I think there’s going to be a push to try to get younger populations [using] these drugs because they’re just so effective, and for young kids we don’t have a lot of additional options outside of inhalers and steroids right now.”

References

1. Menzies-Gow A, Corren J, Bourdin A, et al. Tezepelumab in adults and adolescents with severe, uncontrolled asthma. N Engl J Med. 2021; 384(19):1800-1809. doi: 10.1056/NEJMoa2034975

2. Kelsen SG, Agache IO, Soong W, et al. Astegolimab (anti-ST2) efficacy and safety in adults with severe asthma: a randomized clinical trial. J Allergy Clin Immunol. 2021;148(3):790-798. doi: 10.1016/j.jaci.2021.03.044

3. FDA approves Tezspire™ (tezepelumab-ekko) in the US for severe asthma. News release. Amgen. December 17, 2021. Accessed January 7, 2022. https://www.multivu.com/players/English/8812852-amgen-fda-approval-tezepelumab-severe-asthma-inflammation/

4. Tezspire. package insert. Amgen; 2021. Accessed January 7, 2022. https://www.accessdata.fda.gov/drugsatfda_docs/label/2021/761224s000lbl.pdf

5. Park, B. Tezspire approved as add-on maintenance treatment for severe asthma. MPR. Dec. 20, 2021.

6. Reddel HK, Bacharier LB, Bateman ED, et al. Global Initiative for Asthma Strategy 2021: executive summary and rationale for key changes. Eur Respir J. 2021;59(1):2102730. doi:10.1183/13993003.02730-2021

7. Expert Panel Working Group of the National Heart, Lung, and Blood Institute National Asthma Education and Prevention Program Coordinating Committee (NAEPPCC). 2020 Focused Updates to the Asthma Management Guidelines: A Report from the National Asthma Education and Prevention Program Coordinating Committee Expert Panel Working Group. J Allergy Clin Immunol. 2020;146(6):1217-1270. doi:10.1016/j.jaci.2020

8. Ivanova A, Israel E, LaVange LM, et al. The precision interventions for severe and/or exacerbation-prone asthma (PrecISE) adaptive platform trial: statistical considerations. J Biopharm Stat. 2020;30(6):1026-1037. doi: 10.1080/10543406.2020

9. Bousquet J, Humbert M, Gibson PG, et al. Real-world effectiveness of omalizumab in severe allergic asthma: a meta-analysis of observational studies. J Allergy Clin Immunol Pract. 2021;9(7):2702-2714. doi: 10.1016/j.jaip.2021.01.011

10. Kavanagh JE, Hearn AP, Dhariwal J, et al. Real-world effectiveness of benralizumab in severe eosinophilic asthma. Chest. 2021;159(2):496-506. doi: 10.1016/j.chest.2020.08.2083

Does Hot Water Make It Worse?

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Keeping your skin clean and well moisturized is one of the top self-care tips for managing eczema. However, that doesn’t mean it’s a good idea to soak for hours in a hot bath.

Hot water might feel good on irritated skin and temporarily stop itching, but it will dry out your skin and lead to eczema flare-ups. Showering or bathing in lukewarm water instead can soothe skin and reduce eczema symptoms.

Read on for more information about how hot water may affect your eczema.

A hot shower can help relieve stress and aching muscles, but it’s not the best choice for people with eczema. Hot water can strip your skin of the natural oils it needs to stay healthy. This can make your skin dry and lead to worse itching and irritation. Additionally, hot water can increase inflammation in your skin. It’s recommended to keep your shower or bath temperatures below 86°F (30°C).

Hot water can provide immediate itch relief. Many people with eczema report that very hot water feels good on their skin and takes away the itching and inflammation. This happens because hot water can stimulate the nerves on your skin in a way that’s similar to scratching.

However, while hot water can provide instant relief of symptoms, it will likely make them worse in the long term. Instead of using hot water, you can apply moisturizer or a topical eczema cream. This can stop your itch without causing a worse flare-up later.

It’s important to take a bath or shower at least once a day when you have eczema. A dermatologist can let you know if you need to bathe more or less often for any reason. Keeping your skin clean is important in managing all types of eczema including common types such as atopic dermatitis, contact dermatitis, and rare forms of eczema such as nummular eczema or chronic hand eczema.

Following some eczema-friendly bathing tips can help you or your child with eczema get symptom relief to manage the condition:

  • Only use lukewarm water. Very hot water can dry out skin and make eczema worse.
  • Avoid bubble baths and bath oils. Products such as bubble baths and bath oils often have ingredients that lead to skin irritation and eczema flare-ups.
  • Avoid scrubbing or using soap on eczema. It’s a good idea to avoid directly washing the skin vigorously or with soap if there’s an active eczema rash.
  • Gentle wash eczema-free skin. Hard scrubbing or rubbing the skin may trigger an eczema flare-up.
  • Limit baths to 20 minutes or less. Bathing for longer than 20 minutes can dry out the skin. For some children, 20 minutes is too long. In this case, your child’s dermatologist might recommend limiting baths to 5 or 10 minutes.
  • Apply moisture right away. It’s best to apply a fragrance-free moisturizing lotion to your child’s skin as soon as they get out of the bath. Use a towel to dry their skin and then apply lotion.
  • Try adding bleach to bathwater. The American Academy of Allergy, Asthma & Immunology recommends adding 1/2 cup bleach to a full bathtub or 1/4 cup bleach to a half-filled bathtub to soothe eczema and prevent infections. For babies and toddlers, a teaspoon of bleach can be added to a baby bath.
  • Consider other bath additives. Bubble baths and bath oils aren’t a good idea for children with eczema, but adding oatmeal, baking soda, salt, or vinegar to a bath can help soothe skin. Always check with your child’s dermatologist before trying these bath additions.

Eczema is an autoimmune skin condition that causes red or discolored and itchy patches to appear on your skin. The condition is chronic. Most people with eczema go through periods of clear skin and periods of having eczema rashes. A period of having eczema rashes is called an eczema flare-up.

Eczema is most often diagnosed in children. Some children grow out of eczema symptoms as they age. However, eczema is lifelong in many cases and some people are adults when they are first diagnosed. Symptoms of eczema include:

  • itchy red or discolored patches on the skin
  • dry skin
  • thick skin
  • skin that is warm to the touch
  • infection
  • a rash that resembles goosebumps
  • puss filled areas of skin
  • of hair follicles

Eczema is sometimes confused with other skin conditions. For instance, psoriasis is also a chronic skin condition that can resemble eczema. Just like eczema, it causes rashes and itches on your skin. However, psoriasis patches tend to be white and scaly while eczema patches tend to look red and inflamed. Infections such as chronic mycosis can also lead to rashes that resemble eczema in some people, but they aren’t.

The best way to determine if your skin rash is caused by eczema is to make an appointment with a dermatologist. They can examine your rashes and discuss your symptoms with you. They can also run tests such as skin cultures if they need more information to make a diagnosis.

Hot water can dry out your skin, leading to irritation and itching. It can also trigger an eczema flare-up. It’s a better idea to use warm water in your shower or bath.

Children with eczema should be bathed carefully without bubble bath or bath oils. It’s best to limit baths to 20 minutes and apply moisturizer right after the bath.

A dermatologist can help you manage your eczema and develop a treatment plan.

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4 Discounts That Could Help You Slash Auto Insurance Costs

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Image source: Getty Images

Don’t pay more for auto insurance by passing up these opportunities for savings.


Key points

  • Auto insurance premiums can be expensive, but there are opportunities to save money.
  • Discounts are available to good drivers as well as based on employment relationships.

Auto insurance premiums can cost hundreds or even thousands of dollars per year. And this is one expense drivers can’t avoid, as it’s required by law to have certain types of coverage, and it’s also important to have the right auto insurance in place to protect assets.

The good news is, even though car insurance premiums must be part of every driver’s monthly budget, there are ways to reduce the amount that must be paid. In fact, there are four discounts that motorists should look into taking advantage of in order to save on their insurance coverage.

1. Good driver discounts

Good driver discounts could allow responsible motorists to save around 10% to 30% on the cost of auto insurance premiums. These discounts are available to people who have not been in an accident recently and who are generally careful and cautious behind the wheel.

Different insurers have their own unique rules for how and when responsible drivers are rewarded. Some insurers provide a discount if motorists are accident free for a set number of years, such as three years. Others offer savings for those who have no violations on their record. And some companies even allow motorists to install apps on their phones that monitor their driving. When the apps show safe behavior, savings follows.

2. Defensive driver discounts

It may also be possible to score a discount for a defensive driving course. This could allow motorists to save between 5% and 20% off the cost of insurance premiums. Courses may be available locally or online and typically last for several hours. Drivers should check with their insurer to find out about approved classes that could help them reduce auto insurance premiums.

3. Discounts for employment or membership

It’s very common for car insurance companies to offer discounts to people who work for certain employers or who have a particular type of job. For example, there may be discounts for active duty military members or for people who work for a larger employer that has partnered with the insurer to offer savings.

Sometimes, becoming a member of a particular club or organization can also provide the chance to save on insurance as well. Insurance companies typically have a list of affiliations or memberships that can qualify a motorist for special savings on premiums.

4. Discount for bundling coverage

Finally, if a motorist also needs other types of insurance, it can be cheaper to coverage bundle and get multiple policies from the same company.

Insurers could bundle coverage by insuring several cars with the some insurer, or by insuring a car as well as a motorcycle or boat. It’s also possible to get renters or homeowners insurance from the same company as a car insurer in many cases, and this can also result in a loyalty discount.

The savings could be as much as 25% for those who work with the same insurer for several policies. It can also be more convenient to have only one company to deal with.

Ultimately, drivers may be able to take advantage of all four of these discounts, or any combination of them, and premiums could decline significantly for those who take this opportunity.

Bipartisan bill targets near-total control of online advertising by Facebook, Google

Congressional lawmakers have proposed legislation to break Google and Facebook’s monopoly over digital advertising, accusing the tech giants of profiteering off their market dominance.

Both the House and Senate have introduced the “Competition and Transparency in Digital Advertising Act,” which proponents say would restore and protect fair competition in digital advertising markets that have been dominated by Google and Facebook.

In a statement introducing the bill, Sen. Mike Lee, the bill’s chief sponsor, said it would free the internet from online monopolies.

“This lack of competition in digital advertising means that monopoly rents are being imposed upon every website that is ad-supported and every company—small, medium, or large—that relies on internet advertising to grow its business,” he said. “It is essentially a tax on thousands of American businesses, and thus a tax on millions of American consumers.”

The bill has not yet been scheduled for consideration in the committee in either chamber, and it faces pushback from wary lawmakers, particularly those from California, which is home to Apple, Google parent company Alphabet and Facebook parent company Meta, as well as scores of other tech players.

But it marks another of many attempts by Congress to assert federal control over the flourishing and largely ungoverned online industry.

The bill would ban large digital advertising companies like Google from owning more than one part of the digital ad “ecosystem,” and it would block them from playing a dual role in the advertising process.

Large companies, namely Google, would have to end their ownership of both supply-side platforms and demand-side platforms that have helped them generate significant revenue.

In 2021, Alphabet earned more than $209 billion from advertising and Meta made roughly $115 billion from advertising.

Other Big Tech firms would also be impacted.

Mr. Lee, Utah Republican, said the legislation would likely require Google and Facebook to “divest significant portions” of their ad businesses, which account for a large portion of their ad revenue.

Amazon could also be required to make advertising divestments, and the bill would “impact” Apple’s developing third-party business, Mr. Lee said.

Mr. Lee said Google, Facebook and other Big Tech firms need regulation because they have used massive troves of user data to establish a monopoly over digital advertising that blocks competition and hurts consumers.

The measure has attracted a handful of co-sponsors so far.

Like other Big Tech bills, support comes from a coalition of Republicans and Democrats who demonstrate that the desire to rein in the industry cuts across party lines.

The bill is co-sponsored by Sens. Ted Cruz, Texas Republican, Amy Klobuchar, Minnesota Democrat, and Richard Blumenthal, Connecticut Democrat.

An identical measure was introduced Thursday in the House. It was sponsored by Rep. Ken Buck, a Colorado Republican who has long sought to bring massive tech companies to heel.

Support in the House also spans the political spectrum. Mr. Buck is a member of the arch-conservative House Freedom Caucus. The co-sponsors include Rep. Pramila Jayapal of Washington who chairs the Democrat’s Progressive Caucus.

Reps. Matt Gaetz, Florida Republican, and David CiccilineCicilline, Rhode Island Democrat, are also sponsors.

“The online advertising market is monopolized, opaque, and rigged in favor of just two companies: Google and Facebook,” Rep. Cicilline said.

Despite the broad political coalition backing the bill, its passage, or even floor consideration, is far from guaranteed. Lawmakers in both parties have opposed implementing government controls over flourishing online platforms.

Previous attempts in Congress to implement antitrust reform in the tech industry haven’t gotten very far yet and the window is closing fast this year.

Congress is expected to adjourn by August for a long summer recess. When they return, the midterm elections will be just a few months away and lawmakers typically steer clear of major legislation before facing voters at the polls.

Among the major bills Mr. Buck, Ms. Klobuchar and other proponents hope to pass this Congress is the American Innovation and Choice Online Act, which would ban online businesses such as Amazon and Facebook from giving preference to their services over other advertisers.

The bill has advanced in the Senate and House but has yet to receive a floor vote in either chamber because other lawmakers in both parties say the bill is too broad and would potentially hurt consumers.

Big Tech has enjoyed a firewall of protection from the House and Senate delegation of lawmakers from California.
“While I share the desire to reform digital markets and increase competition, as drafted, the bills fall short and will create more harm than good for American consumers and the US economy,” Rep. Zoe Lofgren, a California Democrat, said in a statement opposing the American Choice and Innovation Online Act and a suite of bills advanced earlier this year to curb tech monopolies.

The tech giants spent millions of dollars lobbying Congress to block federal controls over their industry.

They argue government controls would cause a wide range of problems that would hurt advertisers and consumers.

In a January blog post, Google Global Affairs President Ken Walker said legislation to check big tech could stifle innovation by requiring firms to get approval from the government before launching new programs. Consumers could end up with less helpful apps, lower-quality search results and less security from cyberattacks.

“Antitrust law is about ensuring that companies are competing hard to build their best products for consumers,” Mr. Walker said. “But the vague and sweeping provisions of these bills would break popular products that help consumers and small businesses, only to benefit a handful of companies who brought their pleas to Washington.”

Best No-Bake Cake Recipe Everyone Should Know, According to Chef

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  • I’ve been a chef for 15 years, and I love this recipe for caramelized-banana pudding icebox cake.
  • This dessert calls for store-bought cookies and doesn’t require any baking.
  • You can individually serving the cake in advance to make it much easier.

I’ve been a chef for over 15 years, and icebox cakes are one of my favorite easy, decadent desserts to throw together.

Icebox cakes are made using premade ingredients, like whipped cream and premade cookies, and they must be chilled.

One of my favorite icebox-cake recipes is a mix between tiramisu and banana pudding, which are traditionally made as layered casseroles.

My recipe pulls from the best parts of tiramisu

The ingredients for the caramelized banana pudding cake laid out on wood counter

The ingredients for the caramelized-banana pudding icebox cake

Alissa Fitzgerald


The beauty of icebox cakes is that they’re assembled the day before and simply rest overnight in the fridge, which makes prep a dream.

There’s no baking needed, and the cookies soften overnight from the residual moisture in the pudding and cream.

I use ladyfingers, a common ingredient in tiramisu. I recommend choosing high-quality ones since they’re the base of the cake.

Whisk mixing a bowl of masrcapone mix for caramelized banana pudding

The mascarpone adds a slight hint of silky cheese.

Alissa Fitzgerald


Tiramisu also traditionally calls for mascarpone, a rich and soft cream cheese. In this case, adding the ingredient to the instant pudding mix layers the tang of silky cheese into the banana flavor.

Opt for slightly green bananas

caramelized banana rounds and halves in pan

Caramelize the bananas with butter, brown sugar, and a little salt.

Alissa Fitzgerald


Slightly green bananas better retain their shape when browned in a pan.

By adding the butter, brown sugar, and a pinch of salt, you enhance the caramelized flavors that give this crowd-pleasing dessert an extra wow factor.

Feel free to experiment with adding a tablespoon of rum or bourbon to the pan for a boozy kick.

You can individually portion this tasty dessert to make it easier to serve

Individual servings of caramelized banana pudding cake

You can portion out the cake before refrigerating it.

Alissa Fitzgerald


Everyone loves a big slice from a casserole dish, but portioning the puddings in advance allows your guests to serve themselves, plus you can better control the presentation.

You can use stemmed or stemless wine glasses, little ramekins, or tiny Mason jars.

Ingredients:

  • 3.4-ounce package of banana-pudding mix
  • 2 cups milk or substitute
  • 1 cup mascarpone cheese
  • 3 slightly green bananas
  • 1 tablespoon butter
  • 1/2 cup brown sugar
  • 1 teaspoon kosher salt (plus a little extra for garnish)
  • A 7-ounce package of ladyfingers

Instructions:

  1. Whisk the banana-pudding mix in a large bowl with the milk or substitute until fully combined.
  2. In a separate bowl, add the mascarpone cheese and 4 tablespoons of pudding mix. Break it up with your whisk or hand mixer and incorporate any lumps until smooth and creamy. Add this into the pudding bowl and combine. The mix should slightly thicken while sitting.
  3. Place sliced ​​banana rounds or halves facedown onto a dry pan over medium-high heat. The bottoms should start to brown after a few minutes.
  4. Turn the heat down to medium. Break the butter up into pieces and scatter it around the pan. Let the butter melt completely, then sprinkle brown sugar over the top. Add a pinch of salt and move the pan around to distribute the liquid. Cook until the butter and sugar combine into a rich, bubbling brown color. Turn the heat off and let the contents rest.
  5. Fill your serving container halfway with the mixture of mascarpone and banana pudding. Then tightly pack a layer of ladyfingers, breaking them into halves or thirds when necessary.
  6. Spoon some caramelized bananas into the center of the ladyfinger ring, reserving a few of the nice-looking pieces for garnish. Add more of the pudding mix to the middle. Place a browned banana on top and finish with a pinch of salt.
  7. Place in the refrigerator overnight or for at least two to three hours. Serve cold or at room temperature.

Career advice from the owner of NYC’s Yu and Me Books

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At 27 years old, Lucy Yu is in her second career and living out what she originally planned to be her retirement goal. She’s the owner of Yu and Me Books, New York City’s first Asian American woman-owned bookstore located in Manhattan’s Chinatown.

Yu is a chemical engineer by training and, until recently, worked as a supply chain manager for a food company. In 2021, however, spurred by burnout and finding solace in books, she decided to pursue a lifelong “dream pipe” of opening a bookstore — one that featured works from Asian Americans, authors of color, immigrants and people from marginalized communities.

One night over wine, she Googled “how to run a bookstore” and a few hours later found herself with the outline of a business plan. She raised nearly $16,000 through GoFundMe and poured her life savings into rent, overhead costs and the beginning of her inventory.

By December, Yu and Me Books opened to the public, and in February, Yu quit her day job to focus on running the bookstore full-time. “I just took a shot and hoped it would turn out for the best,” she says.

Yu shared with CNBC Make It the biggest lessons she’s learned throughout a year of becoming a business owner, plus her best book recommendations.

The biggest lesson she learned about running a business

I’m going to make mistakes. That’s for sure. So learning to be less hard on myself has been a big learning curve, but also vital for me to keep a sustainable business going. If I dwell on the small things, even some of the big things, I have to remind myself: Mistakes are bound to happen. I’ve learned to roll with the punches a little more and give myself some breathing room, which is a good life skill in general.

Dealing with imposter syndrome

There are days when I feel I’m at a total loss for what I’m doing. I really don’t have much experience. I don’t know what it’s like to be in the publishing world. And it’s my first time owning a business, especially a bookstore. So I can feel just really defeated at times.

But the motivation I’ve gotten is through the love and support from my friends who tell me: Look at what you’ve created out of a Google search. They’ve really lifted me up when I’ve been down.

The best career advice she’s ever gotten

Be prepared, but don’t let that prepare stifle a leap of faith. My last manager said I had to be a little more open to ambiguity, and so I took that to heart. There’s no way you can predict everything.

Finding support in the business community

While creating my business plan, I called a couple different bookstores for guidance and heard from Noelle Santos of the Lit. Bar in the Bronx. I just asked her basic questions about business insurance, and she was so immediately friendly and said, “if you ever need anything, let me know.”

Emma Straub from Books Are Magic in Brooklyn reached out to me pretty early on in my GoFundMe campaign. She showed up on my opening day with her kids. She owns a bookstore — she doesn’t need books from a different bookstore! But the amount of love she brought to me before she even knew me to show her support was above and beyond.

Yu and Me Books features stories by AAPI writers, immigrants, authors of color and members of marginalized communities.

Courtesy of subject

And the community in Chinatown is phenomenal. It’s the most I’ve felt at home in a neighborhood living in New York City. Every shop owner shows up for each other. I’ll go to Uncle Lou, a new Cantonese restaurant, during the day. Wilson Tang, who owns Nom Wah Tea Parlor, comes in with his kids all the time. And all the community organizers of groups like Welcome to Chinatown and Send Chinatown Love — the way they show up for each other throughout the community is something I’ve really never seen before.

Planning the future two weeks at a time

I hope to extend the store’s reach beyond the community in New York, host book clubs, and make it more of a community event space. I’m working on a liquor license so we can stay open later on the weekends and people can hang out.

But I honestly don’t think past two weeks, which is not ideal for a business owner. But I think with all the unpredictability of everything we’ve experienced in the last three years, you can’t really predict anything. And if I can make it past two weeks, and it’s a really positive, awesome experience, I can do it again two weeks after that.

How she builds her book list

I have around 1,700 titles, and I handpick all of them myself, so I definitely have some blind spots and titles that are missing that I’m working on.

I peruse a lot of Bookstagram. I’m not kidding, these book Instagrammers are out here doing amazing work presenting titles that are not always at the top of big lists. I spend a lot of time on StoryGraph, an app with wonderful recommendations that isn’t owned by Amazon. I spend a lot of time researching and creating my lists every week.

4 book recommendations

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Online Dating Services Market 2021 Business Development-Match,PlentyofFish,OkCupid,Zoosk,eHarmony,JiaYuan,BaiHe,ZheNai,YouYuan,NetEase

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New Jersey, United States,- Mr Accuracy Reports published new research on Global Online Dating Services covering micro level of analysis by competitors and key business segments (2022-2029). The Global Online Dating Services explores comprehensive study on various segments like opportunities, size, development, innovation, sales and overall growth of major players. The research is carried out on primary and secondary statistics sources and it consists both qualitative and quantitative detailing.

Some of the Major Key players profiled in the study are Match, PlentyofFish, OkCupid, Zoosk, eHarmony, JiaYuan, BaiHe, ZheNai, YouYuan, NetEase

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Various factors are responsible for the market’s growth trajectory, which are studied at length in the report. In addition, the report lists down the restraints that are posing threat to the global Online Dating Services market. This report is a consolidation of primary and secondary research, which provides market size, share, dynamics, and forecast for various segments and sub-segments considering the macro and micro environmental factors. It also gauges the bargaining power of suppliers and buyers, threat from new entrants and product substitute, and the degree of competition prevailing in the market.

Global Online Dating Services Market Segmentation:

Online Dating Services Segmentation by Type:

Casual, Socialize, Marriage.

Online Dating Services Segmentation by Application:

Ordinary, LGBT

Key market aspects are illuminated in the report:

Executive Summary: It covers a summary of the most vital studies, the Global Online Dating Services market increasing rate, modest circumstances, market trends, drivers and problems as well as macroscopic pointers.

Study Analysis: Covers major companies, vital market segments, the scope of the products offered in the Global Online Dating Services market, the years measured and the study points.

Company Profile: Each Firm well-defined in this segment is screened based on a products, value, SWOT analysis, their ability and other significant features.

Manufacture by region: This Global Online Dating Services report offers data on imports, exports, sales, production and key companies in all studied regional markets

Market Segmentation: By Geographical Analysis

The Middle East and Africa (GCC Countries and Egypt)
North America (the United States, Mexico, and Canada)
South America (Brazil etc.)
Europe (Turkey, Germany, Russia UK, Italy, France, etc.)
Asia-Pacific (Vietnam, China, Malaysia, Japan, Philippines, Korea, Thailand, India, Indonesia, and Australia)

The cost analysis of the Global Online Dating Services Market has been performed while keeping in view manufacturing expenses, labor cost, and raw materials and their market concentration rate, suppliers, and price trend. Other factors such as supply chain, downstream buyers, and sourcing strategy have been assessed to provide a complete and in-depth view of the market. Buyers of the report will also be exposed to a study on market positioning with factors such as target client, brand strategy, and price strategy taken into consideration.

Key questions answered in the report include:

  • who are the key market players in the Online Dating Services Market?
  • Which are the major regions for dissimilar trades that are expected to eyewitness astonishing growth for the Online Dating Services Market?
  • What are the regional growth trends and the leading revenue-generating regions for the Online Dating Services Market?
  • What will be the market size and the growth rate by the end of the forecast period?
  • What are the key Online Dating Services Market trends impacting the growth of the market?
  • What are the major Product Types of Online Dating Services?
  • What are the major applications of Online Dating Services?
  • Which Online Dating Services Services technologies will top the market in next 7 years?

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Table of Contents

Global Online Dating Services Market Research Report 2022 – 2029

Chapter 1 Online Dating Services Market Overview

Chapter 2 Global Economic Impact on Industry

Chapter 3 Global Market Competition by Manufacturers

Chapter 4 Global Production, Revenue (Value) by Region

Chapter 5 Global Supply (Production), Consumption, Export, Import by Regions

Chapter 6 Global Production, Revenue (Value), Price Trend by Type

Chapter 7 Global Market Analysis by Application

Chapter 8 Manufacturing Cost Analysis

Chapter 9 Industrial Chain, Sourcing Strategy and Downstream Buyers

Chapter 10 Marketing Strategy Analysis, Distributors/Traders

Chapter 11 Market Effect Factors Analysis

Chapter 12 Global Online Dating Services Market Forecast

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Common Cold – or Something More Serious?

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You feel it coming on: itchy eyes, runny nose, a tickle in your throat. Over the next few days, your symptoms progress to include sneezing, congestion, fatigue, cough and a sore throat. Despite your best efforts, it looks like you’ve caught the common cold, and if you’re not attentive it could get worse.

How Common Is the Cold?

Colds are a minor viral infection that account for more doctor visits than any other illness. Adults, on average, catch two to four colds a year — kids even more — with most cases reported between September and May.

Highly contagious, colds spread much like the flu, by droplets of fluid or inhaled. The most common cause, rhinovirus, accounts for more than 40 percent of reported cases, usually last less than 10 days and can be treated with symptom relief medications and rest.

If left unchecked however, a cold can progress to more serious illnesses. And sneezing, congestion and sore throat also can be symptoms of other ailments.

  • Think it might be the flu? Although both viral in nature, colds differ from the flu, which ramps up faster and includes more severe symptoms such as weakness, chills and body aches.

  • Think it might be allergies? Allergies can share symptoms with the common cold, but allergies are noncontagious responses of your immune system to an allergen, frequent seasonal and controllable by antihistamines.

Other Illnesses Can Stem from a Cold

Fighting any minor ailment weakens your immune system, leaving you vulnerable to other illnesses. The four most-common conditions stemming from a common cold virus, or that begin with cold-like symptoms, include:

  • Acute bronchitis – Also called a “chest cold,” acute bronchitis results from excessive mucus in your lungs and swollen airways. This can bring additional health complications such as chest tightness, heavy cough and exhaustion.

  • Sinus infections – Sinusitis occurs when fluid builds up in your sinuses and allows bacteria to grow. This can trigger other symptoms, such as severe facial pain, headaches, earaches and bad breath.

  • Pneumonia – Pneumonia causes fluid to form in the lungs’ air sacs. Though a bacterial infection can cause pneumonia, it more often results from another viral infection, such as a cold or flu. Pneumonia’s symptoms include chest pain, shortness of breath, vomiting and diarrhea. It can become severe and lead to lung abscess or respiratory failure.

  • Strep throat – Strep throat is a highly contagious bacterial infection. It often starts quickly and includes pain with swallowing, fever and swollen neck lymph nodes. At first, the post-nasal drip irritation might look similar to a cold, but since strep is viral, it can be treated with antibiotics.

When To See Your Doctor

While most common colds only come with mild symptoms that are manageable by over-the-counter remedies such as ibuprofen, cough syrups and decongestants, some more critical reactions could warrant a trip to the doctor or emergency room:

  • Prolonged fever above 102 F

  • Symptoms lasting longer than 10 days, or that worsen

  • Shortness of breath or labored breathing

  • Pain or pressure in the chest

  • Lightheadedness or fainting

  • Confusion or disorientation

  • Severe or persistent vomiting, dehydration

  • Severe pain in your face, forehead or ears

If you’re over 65, pregnant or have chronic health conditions such as asthma, diabetes or heart disease, speak with your doctor to find out which medications and treatments are safe and effective.

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Children’s viruses that disappeared during pandemic lockdowns are back, doctors say

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As children emerge from their homes after COVID-19-related lockdowns, common viruses that all but disappeared during the pandemic are re-emerging too, doctors say.

“This time of year in pediatric hospitals, it’s usually quiet,” said Dr. Fatima Kakkar, a pediatric infectious diseases specialist at CHU Sainte-Justine in Montreal. “But now we’re seeing a surge of respiratory infections.”

The level of non-COVID illnesses is what Kakkar usually sees in the fall, she said, when children are out and about in daycares or schools.

While the public health measures taken in the last year — including physical distancing, masking and staying home — were used to stop the spread of COVID-19, they also had the side benefit of preventing other respiratory viruses, including colds, respiratory syncytial virus ( RSV) and human parainfluenza virus, which causes crup.

But experts say that also means because children haven’t come in contact with those viruses for a long time, they haven’t built up the antibodies they normally would — and they won’t have the immunity they might otherwise have.

“What’s happened to us is we … had no exposure,” said Dr. Allison McGeer, an infectious diseases specialist and microbiologist at Sinai Health in Toronto.

“Now that we’re getting back to normal and kids can see each other, we’re starting to see those infections [again] in children.”

Now that kids are emerging from isolation, they’re being exposed to common viruses their immune systems haven’t encountered for more than a year, experts say. (Syda Productions/Shutterstock)

Kids will usually recover from most of these illnesses on their own, but Kakkar said pediatricians are especially worried about a rise in RSV. Although it’s a common virus, it can cause breathing problems in infants and toddlers that are so severe they require hospital care, she said.

Last month, the US Centers for Disease Control and Prevention issued a health advisory notifying health-care providers that RSV cases were on the rise in parts of the country, and asking them to test children with acute respiratory symptoms for RSV if COVID-19 was ruled out.

According to the CDC, RSV is the most common cause of bronchiolitis and pneumonia in children under one.

Flu still to come

One respiratory virus that doctors aren’t seeing yet is the flu, Kakkar said.

But after a year with essentially no flu season, largely due to COVID-19 precautions, influenza is expected to return this fall.

Even though our immune systems may not be ready for the flu this year, there’s good news, doctors say.

“People are worried about the flu coming back. But for the flu, we have a safe and effective vaccine,” said Dr. Ellen Foxman, an immunologist at the Yale School of Medicine in New Haven, Conn.

“This is a great year to get your flu shot if you haven’t done it before,” said Foxman, noting that she gets her three children vaccinated every year.

Although children are getting more respiratory infections, doctors say parents shouldn’t be alarmed.

“This is not a big deal for most children,” McGeer said.

Pediatric infectious diseases specialist Dr. Fatima Kakkar says there’s a ‘surge’ of respiratory infections that her hospital wouldn’t normally see until the fall. (Submitted by Fatima Kakkar )

Plus, she said, parents can use several of the same precautions they’ve learned during the COVID-19 to help prevent the spread of re-emerging childhood pandemic viruses.

“Wash your hands,” McGeer said. “We know that simple things reduce your risk of respiratory viral infections.”

“[There’s] good evidence that washing your hands five times a day reduces the risk by about 30 per cent, give or take.”

Staying home when you’re sick and keeping your child at home if they have symptoms is also a behavior adopted during COVID-19 that needs to continue, Kakkar said.

Plus, parents should be prepared now to deal with viruses they wouldn’t normally expect until the fall.

“Pretend it’s October,” she said.

Maternal Autoimmune Diseases Up Risk of Mental Illness in Children

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Mental disorders were significantly more likely in children whose mothers had one of five common autoimmune diseases, a new study found.

Previous research has linked both maternal and paternal autoimmune diseases and specific mental disorders, such as attention-deficit/hyperactivity disorder (ADHD), but most of these studies focused on specific conditions in relatively small populations. The new study included data on more than 2 million births, making it one of the largest efforts to date to examine the association, according to the researchers, whose findings were published in JAMA Network Open.

Previous evidence of the possible association between certain maternal autoimmune diseases and mental disorders in offspring has been “scattered and limited,” which “hampered an overall understanding” of the link, Fei Li, MD, the corresponding author of the study, told Medscape Medical News.

Li, of Shanghai Jiao Tong University School of Medicine, in China, and her colleagues reviewed data from a Danish registry cohort of singleton births with up to 38 years of follow-up. They explored associations between a range of maternal autoimmune diseases diagnosed before childbirth and the risks of mental disorders in children in early childhood through young adulthood.

The study population included 2,254,234 births and 38,916,359 person-years. Data on mental health were collected from the Psychiatric Central Research Register and the country’s National Patient Register. The median age of the children at the time of assessment was 16.7 years; approximately half were male.

A total of 50,863 children (2.26%) were born to mothers who had been diagnosed with autoimmune diseases before childbirth. During the follow-up period, 5460 children of mothers with autoimmune diseases and 303,092 children of mothers without autoimmune diseases were diagnosed with a mental disorder (10.73% vs 13.76%), according to the researchers.

The risk of being diagnosed with a mental disorder was significantly higher among children of mothers with any autoimmune disease (hazard ratio [HR]1.16), with an incidence of 9.38 vs 7.91 per 1000 person-years, the researchers report.

The increased risk persisted when the results were classified by organ system, including connective tissue (HR, 1.11), endocrine (HR, 1.19), gastrointestinal (HR, 1.11), blood (HR, 1.10), nervous (HR, 1.17), and skin (HR, 1.19).

The five autoimmune diseases in mothers that were most commonly associated mental health disorders in children were type 1 diabetes, rheumatoid arthritis, systemic lupus erythematosus, multiple sclerosis, and psoriasis vulgaris.

The greatest risk for children of mothers with any autoimmune disease was observed for organic conditions such as delirium (HR, 1.54), followed by obsessive-compulsive disorder (HR, 1.42), schizophrenia (HR, 1.54), and mood problems (HR, 1.12).

Children of mothers with any autoimmune disorder also had a significantly increased risk of autism (HR, 1.21), intellectual disability (HR, 1.19), and ADHD (HR, 1.19).

The results add to evidence that activation of the maternal immune system may drive changes in the brain and behavioral problems, which have been observed in animal studies, the researchers write.

Potential underlying genetic mechanisms in need of more exploration include risk factors, maternal transmission of autoantibodies to the fetus during pregnancy, and the increased risk of obstetric complications, such as preterm birth, for women with autoimmune disorders that could affect mental development in children, they add.

The study findings were limited by several factors, including the lack of data on potential exacerbation of autoimmune disease activity during pregnancy and its effect on the fetus, the researchers note. Other limitations included potential detection bias, lack of data on mental disorders in adulthood, and potential changes in diagnostic criteria over the long study period.

The results were strengthened by the use of a population-based registry, the large sample size, and the ability to consider a range of confounders, the researchers say.

“This study could help acquire a comprehensive compilation of the associations between maternal autoimmune disorders diagnosed before childbirth and offspring’s mental disorders from childhood through early adulthood,” Li Medscape Medical News.

For clinicians, Li said, the findings suggest that the offspring of mothers with autoimmune diseases may benefit from long-term surveillance for mental health disorders.

“Further studies should provide more evidence on the detailed associations of specific maternal autoimmune diseases with a full spectrum of mental disorders in offspring, and more research on underlying mechanisms is needed as well,” she said.

Pay Early Attention

M. Susan Jay, MD, an adjunct professor of pediatrics at the Medical College of Wisconsin, Milwaukee, said previous efforts to examine the association between maternal autoimmunity were hampered by study design, small samples, and self-report of disease history ― problems the new research avoids.

The large patient population allowed for detailed subgroup analysis of different conditions and outcomes. Another advantage was the availability of sociodemographic and clinical information, which allowed for the elimination of confounding factors, said Jay, who was not involved in the research.

“It would be prudent to follow children of mothers with autoimmune disorders before or during pregnancy for mental health issues, and if identified clinically, to offer psychological and developmental behavioral support options,” Jay added.

The authors have reported no relevant financial relationships.

JAMA Netw Open. April 15, 2022. Full text

Heidi Splete is a freelance medical journalist with 20 years of experience.

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