The big law firm has been with us for a long time. What keeps changing is our conception of "big." A century ago, no law firm outside of New York City had as many as 7 attorneys.' During the first half of this century, observers like Adolph Berle decried the emergence of "law factories," but the firms they were describing would be boutiques by modern standards.2 By 1960, the "big firm" had assumed a larger scale: the 50 largest firms ranged in size from 50 to 100 lawyers (at 22
Background Over the past few years, several alternative leather technologies have emerged and promise advantages over incumbent leathers with respect to sustainability despite most containing enough plastic to prevent safe and effective biodegradation. Of the alternative leathers in production or advanced development, few fit the dual criteria of low-carbon and near-zero plastic. Reishi™ is a leather alternative, grown using MycoWorks’ Fine Mycelium™ technology, with less than 1% polymer content and satisfies the same performance, quality, and hand feel as animal leather. We present here the first Life Cycle Assessment (LCA) of Reishi™, detailing its “cradle-to-gate” carbon footprint and broader environmental profile. The pilot- and full-scale production of 1 m2 of post-processed, finished, and packaged Reishi™ both before and after production improvement implementations is modeled, and the environmental footprint impact assessment method is performed. Results It was found that Reishi’s™ carbon footprint is as low as 2.76 kg CO2-eq per m2, or 8% of the value of the bovine leather benchmark modeled. Furthermore, it was found that Reishi™ has a lower impact compared to bovine leather modeled across a number of impact categories, including eutrophication, ecotoxicity, human health effects, and others. Reishi’s™ impact “hotspots” were determined, with the largest opportunity for further reduction being improved energy efficiency in the growth of mycelium, in particular, the process’s sterilization of raw material inputs via autoclave tools. It is also shown that MycoWorks’ passive process for growing mycelium has a carbon footprint two orders of magnitude lower than incumbent mycelium growth processes that actively consume carbon dioxide gas, which MycoWorks’ process does not require. Conclusions Reishi™ is shown to be a promising sustainable material through its unique combination of natural quality, low-carbon footprint as determined by this LCA, and biodegradability due to its lack of plastic or crosslinked content. Its manufacturing process is low impact even when produced at a scale of tens of thousands of square meters per year—a miniscule fraction of the billions of square meters of bovine leather already sold per year. With further use of this leather alternative, additional efficiency gains are likely to be realized.
The venerable legal profession has emerged, over the past generation, as one of the nation's fastest growing occupations. In this paper, we suggest that this fact is not mere happenstance, but is part and parcel of other fundamental changes in the "legal services industry. " We attempt to define and clarify these changes by presenting time series data on a number of these developments, including the growth of law as an economic sector, the increasing concentration of law firm activity, and income trends among lawyers. We then offer a simplified demand and supply analysis of the market for lawyers, concluding that several interrelated factors fostered the lawyer boom. In the paper's final sections, we speculate about the forces causing a spiraling demand for legal services and a growing inequality of incomes between the elite firms and sole practitioners.Over the past quarter of a century, the number of practicing attorneys in the United States has tripled. Such dramatic growth suggests that some fundamental change has come to the legal system. That impression is reinforced when one examines other trends among lawyers: the growth of big firms, the changing distribution of lawyer earnings, and the changing content of legal work itself. But somewhat surprisingly, the mushrooming transformations that have come to the legal profession have Richard H.
Introduction The clinical manifestations of COVID-19 infection in recipients of allogeneic hematopoietic stem cell transplantation (HSCT) have been reported in multiple retrospective cohorts of patients, but there have been no prospective studies to date. Previous studies report that HSCT recipients are at higher risk, with cumulative incidence of death between 17-35%. Although an excessive pro-inflammatory viral response has been documented in the general population, its role in the immune incompetent HSCT setting has not been documented. We present a combined prospective and retrospective national study run through the UK IMPACT trial network to characterize the clinical and immunological features of COVID-19 infection in 96 adult and pediatric recipients of HSCT in the United Kingdom. Methods HSCT recipients of any age and transplanted for any indication, with an RT-PCR-proven COVID-19 infection, were eligible for this study. Patients within 72 hours of COVID-19 diagnosis, who had not received cytokine-targeted treatment, were recruited to a prospective cohort. All other patients were eligible for a retrospective cohort. Prospective patients provided blood samples within 72 hours of COVID-19 diagnosis, and again within 72 hours of clinical deterioration (defined as requirement for oxygen administration) if applicable. Follow-up data were collected on patients 30 and 100 days after COVID-19 diagnosis. Results 100 patients were recruited from 16 sites across the UK between May 2020-June 2021, comprising 12 in a prospective cohort and 88 recruited retrospectively. 96 patients were evaluable, as 4 proved ineligible post-registration. Patients were diagnosed with COVID-19 at a median of 11 months after HSCT. Patient/HSCT characteristics are shown Table 1. The most common symptoms associated with the onset of COVID-19 were fever in 8 prospective (73%) and 35 (41%) retrospective patients, followed by cough in 5 (45%) prospective and 35 (41%) retrospective patients and dyspnea in 4 (36%) prospective and 16 (19%) retrospective patients. 8 (73%) prospective and 40 (47%) retrospective patients were actively immunosuppressed at the time of COVID-19 infection. 16% of the patients had moderate/severe disease at baseline. At day 30 (±2 days) after COVID-19 diagnosis, 2 prospective and 8 retrospective patients continued to demonstrate SARS-CoV-2 positivity on respiratory PCR testing. The median time to viral clearance was 40 (IQR 17-78) days for the prospective and 34 (IQR 15-70) days for the retrospective cohort. Prolonged (more than 14 days) neutropenia was reported in 4 (5%) patients in the retrospective cohort, prolonged thrombocytopenia in 2 (18%) prospective and 11 (13%) retrospective patients. 1 retrospective patient developed secondary hemophagocytic lymphohistiocytosis, and graft rejection was reported in 1 (1%) retrospective patient, within 30 days of COVID-19 diagnosis. In the prospective cohort, 3 (27%) patients died, all by day 30, and all due to COVID-19. In the retrospective cohort, 13 (17%) patients died by day 30, rising to 18 (21%) by day 100, 61% of deaths were attributed to COVID-19. Lower baseline platelets (p=0.013, Mann-Whitney U test), lymphocytes (p=0.012), albumin (p=0.028), and higher baseline CRP (p=0.007), were seen in patients who died following COVID-19 diagnosis. Additionally, exploratory univariate logistic regression of the retrospective cohort found mortality at day 100 to be associated with increased age at diagnosis (OR 1.04, 95% CI 1.01-1.08, p=0.04), and no requirement compared with requirement for invasive ventilation (OR 0.02, 95% CI 0.00-0.16, p=0.001). The 11 prospective patients showed normal levels of interleukin (IL)-2, -4, -10, interferon gamma and tumor necrosis factor alpha at COVID-19 presentation. IL-6 was minimally raised (up to 127 pg/ml, nv<50) in 3/11 pts at presentation. Respiratory deterioration was not associated with detectable cytokine storm. Conclusion Our study confirms a significant mortality rate in patients affected by COVID-19 post HSCT and confirms age as well as requirement for invasive ventilation to be independent risk factors associated with death at day 100. Baseline laboratory data at disease presentation can identify patients at higher risk of COVID-19 related death. In the prospective cohort of our study, pathophysiology of the viral disease did not seem related to cytokine storm-mediated inflammation. Figure 1 Figure 1. Disclosures Protheroe: Jazz Pharmaceuticals: Honoraria; Astellas: Honoraria; Kite Gilead: Honoraria. Peggs: Autolus: Consultancy, Current equity holder in publicly-traded company. Craddock: Novartis Pharmaceuticals: Other: Advisory Board ; Celgene/BMS: Membership on an entity's Board of Directors or advisory committees, Research Funding. Nicholson: BMS/Celgene: Consultancy; Kite, a Gilead Company: Other: Conference fees, Speakers Bureau; Novartis: Consultancy, Other: Conference fees; Pfizer: Consultancy. Amrolia: ADC Therapeutics: Other: Named inventor on a patent which is being transferred to ADCT.; Autolus: Patents & Royalties.
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