Free Porn
xbporn
Home Blog Page 212

ALS Blood Test Promises Accurate, Earlier Diagnosis

Admin
-
0


Researchers have developed a blood test for amyotrophic lateral sclerosis (ALS) that could lead to more rapid and accurate diagnosis when used alongside standard clinical evaluations. 

Investigators said the test can distinguish ALS from other neurologic conditions with similar symptoms and has an overall accuracy of nearly 100%.

“We have developed a unique fingerprint of microRNA taken from a standard blood draw that accurately identifies ALS patients at early stages,” Paul Alan Cox, PhD, executive director of Brain Chemistry Labs in Jackson, Wyoming, told Medscape Medical News. “Hopefully, this new test will speed diagnosis by neurologists so treatment can begin earlier and will reduce the rate of misdiagnosis.” 

Cox and colleagues described their work in a paper published online on September 13 in Brain Communications. 

Currently, a diagnosis of ALS is based on a thorough clinical examination, but it can take up to a year to arrive at a definitive diagnosis, by which time many patients are apt to have suffered significant deterioration in symptoms. And rates of misdiagnosis may be as high as 68%, further complicating timely and accurate treatment, investigators noted.

Blood-based diagnostic biomarkers for ALS are “essential” for reducing diagnostic delays and improving disease outcomes, as well as for therapeutic drug development, they added. 

In a series of experiments, the research team identified a unique diagnostic signature in blood samples from patients with ALS made up of eight distinct microRNA sequences. These markers are associated with neuron survival, brain inflammation, memory, and learning. 

This blood signature can distinguish patients with ALS from healthy controls and patients with two other neurologic conditions that can mimic ALS (primary lateral sclerosis and Parkinson’s disease) — with an overall accuracy of up to 98%, they reported.

The researchers envision this blood biomarker test as a “quick secondary measure” of disease diagnosis following a neurologist’s clinical evaluation. 

They said the “enhanced diagnostic confidence” provided by the test would enable neurologists to diagnose patients with ALS at an earlier stage of disease, providing an opportunity for earlier use of disease-modifying ALS drugs.

Brain Chemistry Labs, a not-for-profit research institute, has applied for a patent on the use of this biomarker. As a not-for-profit organization, Cox said they are in discussions with commercial diagnostic firms to make this test available after US Food and Drug Administration approval. 

“In the best case, developing and marketing the test will require approximately 18 months after we select a commercial partner,” Cox said. 

Commenting on this research for Medscape Medical News, Stephen Scelsa, MD, director of the ALS Center, Mount Sinai-Union Square, New York City, said this test could be a “breakthrough.”

“With ALS, we diagnose and start treatment too late. The average time from symptom onset to diagnosis is 11 months in the US and Europe. By the time we start treating patients, it’s less likely that these treatments that have very modest effects are going to help, so to be able to diagnose early is very important,” said Scelsa. 

“The test could give the general neurologist or even the internist some confirmatory information early on, reducing delays in referral to a specialist and starting treatment,” he added. 

The study had no commercial funding. Cox and Scelsa had no relevant conflicts of interest.

Tottenham & Man Utd made contact to sign Fermin Lopez

Admin
-
0
Tottenham & Man Utd made contact to sign Fermin Lopez


Tottenham Hotspur and Manchester United reportedly made contact with Barcelona over a deal to sign Fermin Lopez this summer, as per the transfer journalist Matteo Moretto.

The Lilywhites currently have James Maddison as the only option to deploy in the attacking midfield position. Dejan Kulusevski and Wilson Odobert can also play the number ten role if needed but the duo is more comfortable playing out wide. So, it seems Spurs attempted to sign a new attacking midfielder to create competition for Maddison.

Moretto has reported that Tottenham expressed their interest in signing Lopez from Barcelona and even ‘enquired’ about the details of securing his signature this summer.

Moreover, the journalist says Spurs weren’t the only club that expressed their interest in signing him as Man Utd also opened talks with the Blaugrana over a potential move. But, a deal eventually didn’t materialise as neither the player nor Barcelona considered this deal.

However, Lopez was a squad player for Barcelona last season and following Dani Olmo’s arrival, his chances may dry up even more this season as the Catalan giants have several other options to deploy in the number ten role.

Battle

So, if he eventually can’t find regular game-time this season then he could be persuaded to move in 2025. In that case, Man Utd or Tottenham can manage to secure his signature next summer should either club revive their interest.

The Spaniard has a £338m release clause in his current contract and it is unlikely that Spurs or the Red Devils would attempt to sign him unless Hansi Flick’s side opt to reduce their asking price, especially given he is valued at around £25m by Transfermarkt.

Bruno Fernandes has been the first-choice attacking midfielder for Man Utd. Mason Mount was signed to deputise the Portuguese last year but upon moving to Old Trafford, he has struggled with fitness problems in recent years. Therefore, the Red Devils are seemingly looking to sign a new number ten.

Lopez enjoyed a stellar summer with his national team Spain as he won the European Championship and also guided his country to win the Gold medal in the Olympics.

Lopez could be a shrewd acquisition for Tottenham or Man Utd if either club eventually manage to secure his signature.



Develop and Demonstrate Good Habits

Admin
-
0


Develop and Demonstrate Good Habits 

  • Moral Sensitivity (Psalm 119:11) 
    • Study the Scriptures daily. 
    • Memorize the Beatitudes. 
  • Accountability (James 5:16) 
    • Be open to the truth when others criticize you. 
    • Daily or weekly, talk with a friend who will help you “kick the habit” that plagues you. 
  • Forgiveness (Matthew 6:14–15) 
    • Know that forgiving others is required for you to receive the forgiveness of God. 
    • Forgive by releasing that person into the hands of God. 
  • Communion with God (Psalm 104:34) 
    • Spend time alone with God every day. 
    • Close your mind to invading thoughts and focus on God’s presence and His character.



Source link

Researchers Says Don’t Wait on the Fed Rate Cut to Refinance Your Mortgage

Admin
-
0
Researchers Says Don’t Wait on the Fed Rate Cut to Refinance Your Mortgage


A new paper from Yale professor Kelly Shue argues that consumers mistakenly wait to take out mortgages and other long-term loans when the Fed is expected to cut rates.

Their confusion seems to be related to conflating short-term and long-term rates, which don’t necessarily move in tandem.

In fact, short-term rate moves are typically already baked in to long-term rates, meaning there’s no need to wait until the cut is official for an even lower interest rate.

The savings of short-term rate cuts should already be reflected in the interest rate of a long-term loan such as a 30-year fixed mortgage.

Despite this, home buyers and even professional forecasters tend to get this wrong according to the research.

Short-Term Rates vs. Long-Term Rates

Consumers have long misunderstood the relationship between the Fed and mortgage rates.

Many incorrectly believe that the Fed directly controls mortgage rates. So when the Fed announces a rate cut, prospective home buyers expect mortgage rates to come down as well.

For example, the Fed is widely expected to lower its fed funds rate by 25 (or maybe 50 basis points) at its September 18th meeting.

When this takes place, there will be a slew of articles written about how “mortgage rates fall” and the like.

Some may even assume that the 30-year fixed fell by the same amount, whether it’s 0.25% or .50%.

So if the 30-year fixed was 6.50% the day before the meeting, a hypothetical home buyer might think the going rate is 6.25% or even 6% the next day.

In all likelihood, they’ll probably be disappointed if and when they speak to their loan officer or mortgage broker.

Chances are mortgage rates won’t budge much at all. And perhaps worse, they could actually rise after the Fed announces a rate cut!

This all has to do with short-term and long-term rates, with the fed funds rate a short-term rate and the 30-year fixed a long-term rate.

While they can impact one another, there isn’t a direct correlation. This is why you don’t hear mortgage rate experts telling you to use the fed funds rate to track mortgage rates.

Instead, the 10-year bond yield is a good way to track mortgage rates, since historically they have a very strong correlation.

Simply put, they are both long-term rates and function fairly similarly because many home loans are paid off in a decade or so despite being offered a full 30 years .

Should You Wait for the Fed to Cut Rates Before Refinancing (or Buying a Home)?

That brings us to consumer behavior surrounding rate cuts and hikes. Before we talk about rate cuts, which are finally on the table, let’s talk about rate hikes.

When the Fed is expected to hike rates, people tend to rush out and lock their loan before rates go up even more.

The researchers, which include Professor Shue, Richard Townsend, and Chen Wang, argue that this too is “a mistake.”

They note that knowing “that the Fed plans to gradually increase short rates does not mean that long rates will gradually increase in tandem.”

Conversely, they say “the long rate jumps immediately in response to such an announcement,” meaning there isn’t a rush to lock your rate before the Fed acts.

Now when we flip the script and consider a rate cut, the same logic applies. If you’re waiting to buy a home or refinance your mortgage due to an impending rate cut, it might be a mistake.

The Fed rate cuts are mostly telegraphed in advance and known to market participants. So there won’t be a big surprise on the day of the announcement that leads to a significant improvement.

At least not with regard to the rate cut announcement itself. This is why mortgage rates often defy logic on the day Fed announcements take place.

Sometimes the Fed raises its rate and mortgage rates fall. And sometimes the opposite happens.

And again, this is due to the disparity between short-term and long-term rates.

What About Long-Term Monetary Policy?

While I agree with the researchers on the point of short-term rate cuts already being baked in to longer-term rates like 30-year mortgages, there’s one other thing to consider.

The expected long-term monetary policy of the Fed. If they are just beginning to cut short-term rates, there is a chance long-term rates continue to improve over time.

I know, the researchers already debunked this with their talk about gradually increasing rates, saying people “fail to recognize that the current long rate already reflects future expected changes in short rates.”

And at the moment, the consensus is for the Fed to cut rates 200 basis points or more over the next year, per CME.

By the September 17th, 2025 meeting, the fed funds rate could be in a range of 3% to 3.25%, down from 5.25% to 5.50% currently.

Sure, you could argue that this too is somewhat baked in to long-term rates at the moment, but there’s still a degree of uncertainty.

If and when the Fed does actually begin cutting rates, instead of merely hinting at it, we could see longer-term rates trickle down further.

Of course, that will depend on economic data and things like inflation and unemployment, which will only reveal themselves over time.

But if you look at the rate tightening cycle, which involved 11 Fed rate hikes between early 2022 and mid-2023, you’d see that mortgage rates kept getting worse and worse.

Granted that too was driven by the underlying economic data, namely out-of-control inflation.

Still, the 30-year fixed surged from roughly 3% in early 2022 to around 8% during that span of time. So those who did go out and lock their rate ASAP were rewarded.

Even someone who chose to take out a 30-year fixed in March 2022 was able to snag a ~3% rate versus a rate of nearly 6% by as early as June of that same year.

In other words, what the Fed has already indicated might be baked in to rates today, but what we’ve yet to find out could push rates even lower as time goes on.

There’s no guarantee mortgage rates will continue to decrease from here, but it’s decently likely if economic data continues to come in cold.

Colin Robertson
Latest posts by Colin Robertson (see all)

7 Hidden things you can find in a cruise ship cabin!

Admin
-
0
7 Hidden things you can find in a cruise ship cabin!


Cruise ship cabins are known for their design efficiency, and some of the things you can find in them often surprise first-time cruisers.

I decided to create an article with 7 hidden things that can be found in cruise ship cabins. I will explain how to find them and what their function is.

After you read everything, cruise ship cabins will have no more secrets for you!

1. Storage behind the mirror

In some cruise ship cabins, the mirror in the bathroom or near the vanity doubles as a storage cabinet.

To find out if your mirror hides storage, you might try moving it slightly forward or looking for a way to open it.

If the mirror offers hidden storage, it usually looks deeper than a standard mirror, indicating space behind it for storing items like beauty or body care products.

However, some mirrors, especially corner ones on ships like those of Norwegian Cruise Line, are well disguised, and you wouldn’t know there’s storage behind them unless you try to open them.
In the photo below you can see an example of one of those found on NCL ships.

Storage behind the mirror on Norwegian Cruise Line

Discovering this storage can be a pleasant surprise. It’s a very handy spot to keep your items organized and out of sight.

2. Hidden electrical outlets

Nowadays, staying connected is more important than ever, and cruise ships have adapted to this need by adding more electrical outlets.

Usually, some electrical outlets are perfectly visible and are located over the cabin desk.

Be careful, however, because some may be more hidden and difficult to locate. They can be discreetly installed in drawers, under desks, or behind movable panels.

For example, many cruise ships have electrical outlets on the sides of the bed that are hidden in the lamps. Below you can see a picture of the ones on Royal Caribbean.
They are quite visible, but on some ships they are more hidden.

Check the article on all the electrical plug sockets on Royal Caribbean (list for every ship).

Electrical outlets on a cruise
Electrical outlets on a cruise

3. Clothesline

Many cruise cabins have a hidden retractable clothesline in the shower or bathtub.

This feature is incredibly useful for passengers who enjoy onboard pools or shore excursions that involve water activities.

Swimsuits and small laundry items can be hung and will easily dry overnight.
It’s a thing that I really love because it saves space in the cabin and also reduces the need for frequent laundry services, which can be costly on cruise ships.

The clothesline is typically discreet and tucked away when not in use. Just pull the wire from one end and hook it on the other end.
Below is a picture of the clothesline I found on my last cruise.

Retractable clothesline
Retractable clothesline
Clothesline in a cruise shower
Clothesline in a cruise shower

4. Refrigerator

The mini-fridge in cruise ship cabins is a hidden convenience that can significantly enhance the stay. Very often, it is tucked away within a sleek cabinet or under a desk.

If you can’t find it or open it, just ask the cabin attendant, sometimes it may have been locked by mistake.

While it’s not very large, these refrigerators are perfect for storing snacks, medication that requires cooling, or a bottle of wine for a special occasion.

If you store medication remember to check the temperature of the fridge. Sometimes they don’t cool like normal refrigerators, so if you have any doubts, just ask at the help desk.

Upon arrival, it might be stocked with chargeable items. If you prefer to use the space for personal items, you can also request the removal of these products.

Usually, the drinks inside it are not free. If you are looking for free drinks, check the list of the 10 drinks that are always free on cruise ships.

5. Room service menu

If you want to enjoy a variety of dining options from the comfort of your room, you have to look for the room service menu.

It can often be found in a desk drawer or as part of the interactive TV system.

The menu typically includes a range of choices, from light snacks to full meals. Some items may come with an additional charge so be sure to inquire before ordering.

I must confess that I rarely use room service. I don’t like to spend too much time locked in the cabin, I prefer to go out and enjoy all the spaces on the ship.

6. Luggage mat

An item that always goes unnoticed is the luggage mat. You can find it in the closet or on a shelf, ready to be laid out upon your arrival, or already on the bed.

The mat is designed to protect the bedspread when unpacking or repacking your suitcase. The room steward will usually store it for you afterward, but I usually just place it under the bed with the empty luggage.

Luggage mats are usually customized with the company’s logo. In the picture below you can see the one from Carnival that says “Unpack and choose Fun“.

Remember that you can’t take the mat with you. The things that you can take home from a cruise cabin are all listed here.

Luggage mat on Carnival
Luggage mat on Carnival

7. Laundry bag

Look well in your closet or drawers and you should also find a laundry bag. It will be handy to store all dirty clothes to be sent for washing to the laundry room located on the ship.

For short cruises I almost never use the laundry, however, I still take the bag and put it in my backpack because it can always come in handy.

Remember that if you want to send the clothes to be washed, you must also complete the accompanying form with the details and your laundry preferences.

READ ALSO: 10 Things You Must Never Do in a Cruise Cabin (Can Get You Banned)

BONUS POINT: Hidden Storage

As you probably know, cabins on cruise ships are very small so it’s important to make the best use of space.

Unfortunately, not everyone knows this but there are two excellent spaces for storing suitcases, clothes, or other items.

The first one is under the bed, a perfect spot to store empty suitcases after you’ve unpacked them.

Suitcase under the bed
Suitcase under the bed

The second one is under the bathroom sink. As you can see in the photo below, you can use it to store dirty laundry or bathroom products.

Dirty clothes under the sink
Dirty clothes under the sink

To conclude

I hope this article was helpful and made you discover aspects of the cabins that you had not noticed before.

If there are other hidden items that you noticed and are not on the list, remember you can leave a comment below, I always enjoy reading them.

In addition, If you haven’t yet found the perfect cabin for you, check the article with the tips to find the best cabins on a cruise ship.



Watch 4 Minutes Of Netflix’s Gundam: Requiem For Vengeance

Admin
-
0
Watch 4 Minutes Of Netflix’s Gundam: Requiem For Vengeance



Fans got their first look over the summer at Gundam: Requiem for Vengeance with the trailer premiere, but Netflix released a full four-minute clip of the upcoming film. Part of the long-running Gundam franchise, Requiem for Vengeance is the second production to be done entirely in computer animation–the first being Mobile Suit Gundam MS IGLOO–and the first entire series animated using Epic Games’ Unreal Engine 5.

“In the year 0079 UC (of the Universal Century), the Principality of Zeon declares independence from the Earth Federation, plunging the two nations into war,” the official show synopsis reads. “Thanks to a revolutionary new weapon known as a Mobile Suit, the Zeon Force initially gains the upper hand. However, they lacked the power to take control of the entire Earth, bringing the war to a stalemate.”

The film takes place eleven months into the war, and the clip shows the Earth Federation forces trying to seize a Zeon-controlled base located somewhere in Eastern Europe. As the skirmish goes on, pilot Iria Sorari and the Red Wolves division, a Mobile Suit platoon, join the fray.

Written by Gavin Hignight (Tekken: Bloodline) and directed by Erasmus Brosdau, the film is a collaboration of animation powerhouses Sunrise and SAFEHOUSE, Inc.

Gundam: Requiem for Vengeance premieres October 17, exclusively on Netflix.



Source link

What Are The Best Sheets For You COCOCOZY

Admin
-
0
What Are The Best Sheets For You COCOCOZY


Cotton is great for those who may overheat in their sleep. Cotton is a naturally breathable material, meaning that heat won’t become trapped in the sheets and thus overheat your body. This keeps you comfortable and cool all night long, especially when compared to synthetic sheets. As far as natural materials go, cotton is one of the more durable options. This will save you from buying new sheets more often.

Cotton also comes in several varieties. The difference is based on the weaving. Some of the most popular ones are:

  • Flannel: A brushed weave, associated with warmth and winter wear
  • Sateen: A denser weave that is warm, but not as warm as flannel
  • Twill: A diagonal weave pattern, known for being highly durable
  • Percale: A durable, crisp pattern known for being light-resistant

Cotton sheets also come in various levels of quality. One of the ways this is measured is by thread count. Thread count indicates the number of threads woven into one square inch of fabric. This is essentially a measure of how tightly woven the fabric is. The higher the thread count, the more tightly woven the sheet is (aka higher-quality sheets).

Linen is a plant-based fabric that’s made from the flax plant’s fibers. Linen sheets are another great option for those who may be hot sleepers. The materials are made to be durable and breathable, providing comfortability. They help regulate temperature, keeping you cool in warm temperatures and warm in cooler temperatures. The linen material is also quite absorbent. Its moisture-wicking ability helps pull away sweat from the skin.

The look of linen bedding also gives a very relaxed and elegant appearance. Its natural drape adds texture to the bed. But don’t be fooled by its delicate appearance. Linen is actually 2-3x stronger cotton. High-quality linen bedding can last for years (maybe even a whole decade).

Satin is a gorgeous fabric. But it is more than its looks, it’s also an amazing fabric to sleep on. Satin can be made from different textiles: silk, cotton, wool, rayon, and polyester. As long as the threads are woven using the right methods, satin can be made.

Satin is another great temperature-regulating bedding. They help keep you cool when it’s hot and keep you warm when it’s cold. The fabric is also hypoallergenic. Satin sheets made from silk are hypoallergenic and more hygienic than other fabrics because they don’t absorb moisture the way cotton does. This type of bedding has a sleek and shiny look to it, giving it a luxurious and elegant look.

Satin is also a great fabric to sleep on as it provides benefits to your hair and skin as well. They help prevent hair breakage and tangles when you sleep and also help to avoid wrinkles. When you sleep on fabrics and bedding that aren’t as smooth as satin, it can create friction between the bedding and your skin. This can lead to more wrinkles (that could’ve been prevented) in the long run.

Silk is the “it girl” of the bedding community. It is quite expensive but for good reason. True silk bedding is similar to satin in that it helps keep your hair and skin healthier. However, the process of making silk and satin is a bit different. As discussed earlier, satin can be created from various materials, including synthetic fibers and silk. Silk, however, can only be made with silk. The process of making silk is labor-intensive. The sourcing is limited in availability but it’s high in demand. Silk is also costly to produce because of its long process to create the fabric. This is why true silk has such a high price tag. It is the epitome of luxury.

Silk is also naturally hypoallergenic because of a protein called sericin, which coats each silk thread, repelling allergens, dust mites, and fungus. This is an all-around great material to sleep on if you want to experience top-notch comfort when sleeping.

For more places to buy the best and most luxurious and comfortable sheets, here are a couple of brands to check out:

 

feature pic: @ashleytstark| design by @lifetime_interior_design





Source link

Five Simple Ways to Welcome Autumn to Your Home

Admin
-
0
Five Simple Ways to Welcome Autumn to Your Home


This Post May Contain Affiliate Links. Please Read Our Disclosure Policy here

This post is in partnership with Wayfair

My home is getting cozier just in time for the upcoming arrival of autumn! Today I will share five fall ideas plus some new pieces I recently added to my home from Wayfair.

I hope these ideas will inspire you in your home!

1. Bring in a subtle touch of the season

The first thing I was looking for was a pretty garland because I knew I could use in a variety of ways around the house. As soon as I took this one out of the package I had a fun idea, what if I wrapped around my dining light? AHHH! So glad I tried it. It is perfect. The flexible leaves made it easy to drape around the rim of the light. If you have a large light you might want two! I love this one so much I am ordering a second to use in another part of the house.

I also found a pretty teak hand carved shallow bowl (reminds me of a long narrow dough bowl) for the center of the table. It is an ideal size for every day so you can still eat around the table and have a conversation without a hug centerpiece in the way. I think it will be fun to create different seasonal centerpieces with this, too. This time I used a few items I already had like faux artichokes (here are similar ones), some pinecones, fresh eucalyptus and tucked in a few flameless votive candles.

2. Set the table for fall gatherings

I’ve been looking for two handled bowls for awhile. These bowls are adorable and just the right size for all kinds of fall comfort food. We’ll use them for oatmeal, soups, desserts and more. They come in several colors (see them all here). They are so cute with our blue and white plates, too (which always feel like fall dishes to me because of the pattern and the pheasants. They also come in brown.

We are casual people and want our home to be very livable for family, grand babies and pups, too. I got these cozy woven placements and set of narrow ticking stripe cloth napkins.

I know we’ll use them all the time for our every day meals as well as when family is over!

Lamp with Scalloped Shade (color and size options)

3. Create cozier daily and seasonal rituals

Mugs get a lot of use in our home so I never hesitate to add new ones to our collection and let older ones go. We chose our favorite mugs to be a part of our seasonal daily rituals. Our family loves the tradition of selecting their mug! These mugs come in a set of SIX, two of each color. They are really nice quality, I’m so glad I found them! Each mug is heavier like a stoneware and the colors are lovely for this season as well as a nice complement to my every day home palette.

Mug Source // Lamp with Scalloped Shade (color and size options)

We try to pay attention to the every day experiences and pieces that we know we’ll enjoy most often, rather than collecting a lot of “special occasion” or overly seasonal specific decor.

4. Layer in comfort.

Rugs add a warm touch to any room. With a more “open concept” floor plan we use rugs all the time to define spaces and coordinate our decor without matching. This rug is beautiful and has held up well to a lot of traffic. I never worry about spills when we’re gathering people in the dining room for meals! It feels so comfortable and cozy in fall.

5. Add a warm glow.

I found some beautiful taper candles (set of three). While I most often use flameless for safety, nothing really beats the mood of a real flame in fall when it’s so dark and dreary out. I love the three styles this set comes with, they are all different textures. They come in tons of other colors, too, like this rust set, or this sage green, brighter blue, and several other options here.

Jute and Cotton Rug Source

Faux Artichokes (similar)

Faux Eucalyptus Garland (on chandelier)

Cotton Striped Napkins

Jute Round Placemats

Blue Soup Bowls (color options)

Blue Taper Candles

Blue and White Plates

Floral Mugs

Teak Wood Dough Bowl

Patterned Rug

Gold Flatware

If you missed our fall refresh in the entry, you can find it here!



Source link

Banks Face Pressure to Fund Affordable Housing Projects, Opening an Opportunity for Investors

Admin
-
0


Affordable housing might be a priority for the government, but that doesn’t mean banks share the same view. According to a recent CoStar article, 11 federal home loan banks say that government pressure to fund their housing programs could threaten their stability.

The Biden administration requires federal banks to contribute money through grants for affordable housing initiatives. According to a White House press release, the president proposed that “each Federal Home Loan Bank double its annual contribution to the Affordable Housing Program, which will raise an additional $3.79 billion for affordable housing over the next decade and assist nearly 380,0000 households.” 

Banks and the Affordable Housing Program

Home loan banks include Fannie Mae and Freddie Mac, government-sponsored enterprises charged with making the housing market more efficient while contributing to affordable housing development. Other consortium members include commercial banks and other financial companies that offer to make loans to federal banks as collateral in exchange for their business. 

However, the 11 federal banks say Biden’s plan amounts to sheer bad business and made a counterproposal. They sent a letter to the U.S. Treasury, suggesting regulators make it easier for bank members to access the grants.

According to the Council of Federal Home Loan Banks, a trade association that serves as the banks’ public voice, the government program yielded $725 million in 2023 for multifamily housing development and individual homeowners and borrowers. 

Federal banks are currently required by law to meet the 10% threshold for affordable housing. Last year, they voluntarily started setting aside 15% of net income for the program. However, If banks doubled their contributions to the Affordable Housing Program from 10% to 20% of net income, as President Biden proposed, the banks claim their ability to fulfill their core financial mission could be compromised.

“We are opposed to any approach that could weaken our capital position, as this would ultimately diminish our ability to fulfill our statutory mandate of providing liquidity to the financial system and supporting housing finance and community development,” said an Aug. 29 letter written by the 11 board chairs.

U.S. Senator Catherine Cortez Masto of Nevada, who introduced the 20% contribution legislation in 2021, contends that while banks claim financial hardship, they have still “paid millions to executives and board members” over the past year.

Reforming Housing Grant Rules

The Affordable Housing Program is not new. It was started in 1989, and the money it generates, along with other home loan bank programs, helps prospective buyers who earn 80% or less of an area’s median income become homeowners. It also supports rental housing in which at least 20% of units are for households at or below 50% of an area’s median income.

The 11 bank presidents claim in their letter that reforming housing grant rules would make it easier for smaller member banks to access the funding. The letter also proposes making it easier for community development financial institutions to access the banks’ Community Investment Program, which provided $4.2 billion in housing loans last year.

Best Banks for Real Estate Investors

As long as a real estate investor is successful, most banks will be willing to veer away from their standard playbook to accommodate them. However, when choosing a bank, knowing exactly what role you want them to play is important, as each has strengths and weaknesses. 

Some banks are superconservative regarding loans for investment properties or business lines of credit related to real estate. Most are more amenable to high-net-worth individuals with high credit scores.

“Large banks like Chase offer standard loan products for standard clients,” said Terence Young, a commercial mortgage broker with eFunder, in a statement to BiggerPockets. “They are not going to change their lending criteria for an average-net worth borrower. However, my high-net-worth clients will audition banks like them and Bank of America to see who will offer them the lowest rate because they want their business.

Young continues:

“A lower-income borrower is just happy to get a loan from whoever will give it to them, sometimes regardless of the rate. That’s where community banks and credit unions come in. They get an incentive from the government to offer loans that the larger banks won’t touch. For investors scaling their portfolio with smaller houses, they can be a tremendous asset because they are invested in the community and want to see small businesses succeed. They will take more of a holistic approach to lending, analyzing deals on a case-by-case basis, instead of a one-size-fits-all loan product.”

How Real Estate Investors Can Benefit From Affordable Housing Initiatives

Affordable housing can be lucrative for investors, particularly developers, thanks to tax credits when a certain percentage of units in a rental building are dedicated to lower-income households and rented below market. While many investors balk at affordable housing, thinking only of Section 8 and the problems it has been known to entail, there are many other ways investors can benefit from affordable housing. 

Renting to adults 65 or older

The 65+ population has grown 34%, from 43 million in 2012 to 58 million in 2022. Government rental assistance provides essential support to low-income older adults; details can be found on the HUD website.

HUD also provides funding for “owners of eligible developments with a grant to convert some or all of the dwelling units in the project into an Assisted Living Facility (ALF) or Service-Enriched Housing (SEH) for elderly residents aging in place.”

Renting to veterans with disabilities

According to the U.S. Department of Veterans Affairs website: 

“HUD provides rental assistance vouchers for privately owned housing to veterans who are experiencing homelessness. VA case managers may connect these veterans with support services such as healthcare, mental health treatment, and substance use counseling to help them in their recovery process and with their ability to maintain housing in the community.” 

Supportive housing for persons with disabilities

Investors can provide housing for people and property owners with disabilities, with federal home modification grants available for housing veterans with disabilities, provided you own and live in the home. However, investors who rent a unit of their small multiunit home to a veteran family member with disabilities will also be eligible for the grants. These also cover homes you intend to buy but do not yet own. State and local home modification grants are less restrictive.

Final Thoughts

Affordable housing is the most incentivized it has ever been. The government is keen to partner with investors and developers to build and offer low-cost housing. The Federal Housing Administration (FHA) and Federal Financing Bank (FFB) Risk-Share Program provides capital to state and local housing finance agencies (HFAs), enabling them to ensure multifamily loans at reduced interest rates and create and preserve high-quality, affordable rental homes.

Funding is available across the board for affordable housing projects. Whether you want to build large multifamily apartment buildings, buy and renovate two to four units, rent to low-income veterans or tenants with disabilities, or build an ADU with FHA-insured financing, there appears to be a deluge of government funds to help investors accomplish their goals—despite some banks opposing the extra money they are being asked to provide.

Ready to succeed in real estate investing? Create a free BiggerPockets account to learn about investment strategies; ask questions and get answers from our community of +2 million members; connect with investor-friendly agents; and so much more.

Note By BiggerPockets: These are opinions written by the author and do not necessarily represent the opinions of BiggerPockets.

Computer-aided diagnosis for lung cancer screening

Admin
-
0
Computer-aided diagnosis for lung cancer screening



Posted by Atilla Kiraly, Software Engineer, and Rory Pilgrim, Product Manager, Google Research

Lung cancer is the leading cause of cancer-related deaths globally with 1.8 million deaths reported in 2020. Late diagnosis dramatically reduces the chances of survival. Lung cancer screening via computed tomography (CT), which provides a detailed 3D image of the lungs, has been shown to reduce mortality in high-risk populations by at least 20% by detecting potential signs of cancers earlier. In the US, screening involves annual scans, with some countries or cases recommending more or less frequent scans.

The United States Preventive Services Task Force recently expanded lung cancer screening recommendations by roughly 80%, which is expected to increase screening access for women and racial and ethnic minority groups. However, false positives (i.e., incorrectly reporting a potential cancer in a cancer-free patient) can cause anxiety and lead to unnecessary procedures for patients while increasing costs for the healthcare system. Moreover, efficiency in screening a large number of individuals can be challenging depending on healthcare infrastructure and radiologist availability.

At Google we have previously developed machine learning (ML) models for lung cancer detection, and have evaluated their ability to automatically detect and classify regions that show signs of potential cancer. Performance has been shown to be comparable to that of specialists in detecting possible cancer. While they have achieved high performance, effectively communicating findings in realistic environments is necessary to realize their full potential.

To that end, in “Assistive AI in Lung Cancer Screening: A Retrospective Multinational Study in the US and Japan”, published in Radiology AI, we investigate how ML models can effectively communicate findings to radiologists. We also introduce a generalizable user-centric interface to help radiologists leverage such models for lung cancer screening. The system takes CT imaging as input and outputs a cancer suspicion rating using four categories (no suspicion, probably benign, suspicious, highly suspicious) along with the corresponding regions of interest. We evaluate the system’s utility in improving clinician performance through randomized reader studies in both the US and Japan, using the local cancer scoring systems (Lung-RADSs V1.1 and Sendai Score) and image viewers that mimic realistic settings. We found that reader specificity increases with model assistance in both reader studies. To accelerate progress in conducting similar studies with ML models, we have open-sourced code to process CT images and generate images compatible with the picture archiving and communication system (PACS) used by radiologists.

Developing an interface to communicate model results

Integrating ML models into radiologist workflows involves understanding the nuances and goals of their tasks to meaningfully support them. In the case of lung cancer screening, hospitals follow various country-specific guidelines that are regularly updated. For example, in the US, Lung-RADs V1.1 assigns an alpha-numeric score to indicate the lung cancer risk and follow-up recommendations. When assessing patients, radiologists load the CT in their workstation to read the case, find lung nodules or lesions, and apply set guidelines to determine follow-up decisions.

Our first step was to improve the previously developed ML models through additional training data and architectural improvements, including self-attention. Then, instead of targeting specific guidelines, we experimented with a complementary way of communicating AI results independent of guidelines or their particular versions. Specifically, the system output offers a suspicion rating and localization (regions of interest) for the user to consider in conjunction with their own specific guidelines. The interface produces output images directly associated with the CT study, requiring no changes to the user’s workstation. The radiologist only needs to review a small set of additional images. There is no other change to their system or interaction with the system.

Example of the assistive lung cancer screening system outputs. Results for the radiologist’s evaluation are visualized on the location of the CT volume where the suspicious lesion is found. The overall suspicion is displayed at the top of the CT images. Circles highlight the suspicious lesions while squares show a rendering of the same lesion from a different perspective, called a sagittal view.

The assistive lung cancer screening system comprises 13 models and has a high-level architecture similar to the end-to-end system used in prior work. The models coordinate with each other to first segment the lungs, obtain an overall assessment, locate three suspicious regions, then use the information to assign a suspicion rating to each region. The system was deployed on Google Cloud using a Google Kubernetes Engine (GKE) that pulled the images, ran the ML models, and provided results. This allows scalability and directly connects to servers where the images are stored in DICOM stores.

Outline of the Google Cloud deployment of the assistive lung cancer screening system and the directional calling flow for the individual components that serve the images and compute results. Images are served to the viewer and to the system using Google Cloud services. The system is run on a Google Kubernetes Engine that pulls the images, processes them, and writes them back into the DICOM store.

Reader studies

To evaluate the system’s utility in improving clinical performance, we conducted two reader studies (i.e., experiments designed to assess clinical performance comparing expert performance with and without the aid of a technology) with 12 radiologists using pre-existing, de-identified CT scans. We presented 627 challenging cases to 6 US-based and 6 Japan-based radiologists. In the experimental setup, readers were divided into two groups that read each case twice, with and without assistance from the model. Readers were asked to apply scoring guidelines they typically use in their clinical practice and report their overall suspicion of cancer for each case. We then compared the results of the reader’s responses to measure the impact of the model on their workflow and decisions. The score and suspicion level were judged against the actual cancer outcomes of the individuals to measure sensitivity, specificity, and area under the ROC curve (AUC) values. These were compared with and without assistance.

A multi-case multi-reader study involves each case being reviewed by each reader twice, once with ML system assistance and once without. In this visualization one reader first reviews Set A without assistance (blue) and then with assistance (orange) after a wash-out period. A second reader group follows the opposite path by reading the same set of cases Set A with assistance first. Readers are randomized to these groups to remove the effect of ordering.

The ability to conduct these studies using the same interface highlights its generalizability to completely different cancer scoring systems, and the generalization of the model and assistive capability to different patient populations. Our study results demonstrated that when radiologists used the system in their clinical evaluation, they had an increased ability to correctly identify lung images without actionable lung cancer findings (i.e., specificity) by an absolute 5–7% compared to when they didn’t use the assistive system. This potentially means that for every 15–20 patients screened, one may be able to avoid unnecessary follow-up procedures, thus reducing their anxiety and the burden on the health care system. This can, in turn, help improve the sustainability of lung cancer screening programs, particularly as more people become eligible for screening.

Reader specificity increases with ML model assistance in both the US-based and Japan-based reader studies. Specificity values were derived from reader scores from actionable findings (something suspicious was found) versus no actionable findings, compared against the true cancer outcome of the individual. Under model assistance, readers flagged fewer cancer-negative individuals for follow-up visits. Sensitivity for cancer positive individuals remained the same.

Translating this into real-world impact through partnership

The system results demonstrate the potential for fewer follow-up visits, reduced anxiety, as well lower overall costs for lung cancer screening. In an effort to translate this research into real-world clinical impact, we are working with: DeepHealth, a leading AI-powered health informatics provider; and Apollo Radiology International a leading provider of Radiology services in India to explore paths for incorporating this system into future products. In addition, we are looking to help other researchers studying how best to integrate ML model results into clinical workflows by open sourcing code used for the reader study and incorporating the insights described in this blog. We hope that this will help accelerate medical imaging researchers looking to conduct reader studies for their AI models, and catalyze translational research in the field.

Acknowledgements

Key contributors to this project include Corbin Cunningham, Zaid Nabulsi, Ryan Najafi, Jie Yang, Charles Lau, Joseph R. Ledsam, Wenxing Ye, Diego Ardila, Scott M. McKinney, Rory Pilgrim, Hiroaki Saito, Yasuteru Shimamura, Mozziyar Etemadi, Yun Liu, David Melnick, Sunny Jansen, Nadia Harhen, David P. Nadich, Mikhail Fomitchev, Ziyad Helali, Shabir Adeel, Greg S. Corrado, Lily Peng, Daniel Tse, Shravya Shetty, Shruthi Prabhakara, Neeral Beladia, and Krish Eswaran. Thanks to Arnav Agharwal and Andrew Sellergren for their open sourcing support and Vivek Natarajan and Michael D. Howell for their feedback. Sincere appreciation also goes to the radiologists who enabled this work with their image interpretation and annotation efforts throughout the study, and Jonny Wong and Carli Sampson for coordinating the reader studies.

1...211212213...247Page 212 of 247
© Newspaper WordPress Theme by TagDiv