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  • NeurologyLive® Brain Games: July 6, 2025

    NeurologyLive® Brain Games: July 6, 2025

    Welcome to NeurologyLive® Brain Games! This weekly quiz series, which goes live every Sunday morning, will feature questions on a variety of clinical and historical neurology topics, written by physicians, clinicians, and experts in the fields of neurological care and advocacy.

    Test your mettle each week with 3 questions that cover a variety of aspects in the field of neurology, with a focus on dementia and Alzheimer disease, epilepsy and seizure disorders, headache and migraine, movement disorders, multiple sclerosis, neuromuscular disorders, sleep disorders, and stroke and cerebrovascular disease.

    This week’s questions include the theme of Stroke triage

    Click here to check out the prior iterations of Brain Games.

    Interested in submitting quiz questions? Contact our editor, Marco Meglio, via email: mmeglio@neurologylive.com.

    Which stroke triage scale is designed to rapidly identify large vessel occlusion (LVO) in the prehospital setting?

    What is the maximum time window from symptom onset to qualify for mechanical thrombectomy, according to the DAWN trial criteria?

    Which of the following is a key reason for prehospital stroke triage protocols directing patients with suspected LVO to comprehensive stroke centers (CSCs)?

    How did you do on this week’s quiz? Let us know with a response to the poll below. Don’t forget to share and compare your results with your friends!

    How many questions did you get correct?

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  • Bilal Chughtai, MD, discusses pivotal trial of the Butterfly device for BPH

    Bilal Chughtai, MD, discusses pivotal trial of the Butterfly device for BPH

    The Butterfly Prostatic Retraction device is currently under investigation in a prospective pivotal trial (NCT05341661) in men with lower urinary tract symptoms secondary to benign prostatic hyperplasia (BPH).1

    In a recent interview with Urology Times®, Bilal I. Chughtai, MD, walked through the design and potential implications of the trial for clinical practice. Chughtai is the chief of urology at Plainview Hospital at Northwell Health in Syosset, New York.

    The study has completed enrollment at 245 patients. To be eligible for enrollment, patients needed to be aged 50 years or older and have a prostate length between 25 mm to 45 mm, a prostate volume between 30 to 90 mL, and symptomatic BPH.

    Those included in the study were randomly assigned 2:1 to receive the Butterfly device or a sham comparator. Patients in the sham arm are able to crossover to the treatment arm at 3 months.

    The primary end points for the study include change in International Prostate Symptom Score at 3 months and 12 months. Primary completion of the trial is expected in December 2025.

    During the discussion, Chughtai also touched on the potential impact of this device if approved, saying, “Once we have a device like this, I think we’re going to see a paradigm-shift. I think there’s going to be shift away from medications, which have been shown to have additional effects…These meds aren’t as safe as we thought.”

    He added, “I think this is going to fill a niche where patients can get an option that is local, reversible, and get decent relief.”

    REFERENCE

    1. Butterfly pivotal study. ClinicalTrials.gov. Last updated January 15, 2025. Accessed July 6, 2025. https://clinicaltrials.gov/study/NCT05341661

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  • Loneliness predicts an increase in TV viewing for older women, but not for men

    Loneliness predicts an increase in TV viewing for older women, but not for men

    Follow PsyPost on Google News

    Middle-aged and older women who say they feel lonely are likely to spend more hours in front of the television a few years later, according to a new longitudinal study published in the Journal of Affective Disorders. In contrast, men in the same age range showed no comparable pattern, and watching additional television did not predict becoming lonelier over time for either gender.

    The research team, led by Zijun Liu and Liye Zou at Shenzhen University’s Body-Brain-Mind Laboratory, set out to clarify how social disconnection and sedentary leisure might be linked. The World Health Organization recently identified loneliness among older adults as a growing public-health issue, while public-health bodies also warn about the health risks that accompany prolonged sitting and screen time.

    Although snapshots of data have linked both issues—people who sit more often report feeling lonelier—previous studies could not determine which tends to come first. The authors wanted to know whether feeling lonely drives people toward the television or whether long hours on the couch quietly erode social ties over the years. Untangling that timeline could help guide interventions that aim to improve emotional wellbeing and reduce passive screen habits later in life.

    “Sedentary behavior research is a newly emerging but rapidly growing field, partly because the 2020 guidelines on physical activity and sedentary behavior issued by the World Health Organization (WHO) did not specify a quantitative threshold for sedentary behavior,” explained Zou, a full professor of psychology. “Given its correlates of adverse outcomes such as cardiovascular disease, mental disorders, and obesity, sedentary behavior has increasingly been recognized as a critical public health concern. Meanwhile, the WHO has declared loneliness in ageing populations to be a significant and growing social-economic burden.”

    “As a key marker of leisure-time sedentary behavior, watching TV is the most prevalent sedentary behavior in ageing populations. In the context of healthy ageing policies, a deeper understanding of the temporal relationship between loneliness and TV viewing is crucial. This could help us determine whether sedentary behavior or loneliness should be prioritized for the targeted intervention, thus optimising the allocation of public health resources and improving the efficiency of interventions.”

    To answer these questions, the researchers drew on the English Longitudinal Study of Ageing, a nationally representative cohort that has tracked the health and lifestyles of adults aged fifty and older since the early 2000s. The present analysis focused on three survey waves collected between 2008 and 2013. After excluding respondents with missing data or implausibly high viewing times, the final sample included 6,788 participants—3,684 women and 3,104 men—with an average baseline age in the early sixties.

    Each participant answered two straightforward questions about weekday and weekend television viewing, from which the researchers calculated daily hours. Feelings of social disconnection were measured with the three-item University of California Los Angeles Loneliness Scale, which asks how often someone lacks companionship, feels left out, or feels isolated. Scores can range from three to nine, with higher numbers reflecting more frequent loneliness.

    The team also collected a broad set of background characteristics that could muddy the picture: age bracket, marital status, educational attainment, employment, body-mass index, physical-activity frequency, and symptoms of depression. Including these factors in the statistical models helped isolate the unique contribution of loneliness and television habits to one another.

    To track influence across time rather than at one moment, Liu and colleagues used random-intercept cross-lagged panel models. This method separates two kinds of patterns: stable differences between people (for example, the fact that some individuals are both lonelier and more sedentary than their peers across the entire study) and within-person changes (for example, whether a spike in loneliness in one wave predicted a later increase in personal viewing hours). Models were run separately for women and men so any sex-specific effects would be visible.

    Several descriptive trends emerged before the directional tests began. At baseline, women reported slightly higher loneliness scores than men and also watched about half an hour more television per day, on average. Across the full six-year span, television time and loneliness were positively related at the between-person level for both sexes. People who generally spent longer in front of the screen also tended to rate themselves as lonelier, suggesting a stable link between the two traits across the population.

    The heart of the study lay in the lagged paths that connected one wave to the next. For women, feeling lonelier during one survey wave predicted an uptick in daily television viewing—about a 9-minute increase for each one-point rise on the loneliness scale—by the time the next survey rolled around two years later. That association held after the researchers accounted for physical activity, marital changes, and the other covariates.

    No evidence suggested that heavier viewing later made women feel lonelier. In men, neither direction reached statistical significance, even though they showed the same between-person link. Both women and men displayed strong stability in loneliness itself: those who felt isolated at one survey tended to report similar feelings two years on.

    “This study provides new evidence suggesting that loneliness may be a predictor of TV viewing time,” Zou told PsyPost. “No evidence was found for a converse effect, meaning that loneliness and TV viewing were not bidirectionally related. An observed sex difference indicates that loneliness may predict increased time spent viewing TV in middle-aged and older women, but not men. This highlights the need for targeted interventions to address loneliness in ageing women.”

    Taken together, the findings paint a picture in which loneliness in women, but not men, sets the stage for more time spent watching television as the years go by. Because the analysis controlled for depressive symptoms and exercise frequency, the effect of loneliness appears to stand somewhat apart from these related influences.

    One interpretation is that television provides a convenient and socially acceptable way to fill time and attention when face-to-face interaction feels out of reach. The set may serve as an emotional companion or simply a distraction that is easier to access than community activities. The absence of a similar pattern in men raises questions about how older men manage feelings of isolation—some may under-report loneliness due to social expectations, or they may seek different outlets such as hobbies away from screens.

    “This study reveals an important connection between loneliness and a specific type of sedentary behavior, TV viewing, particularly among middle-aged and older women,” Zou explained. “We found that increased TV viewing time can be predicted by levels of loneliness. This highlights the importance of raising awareness of the phenomenon of loneliness for the general public, and the need for relevant innovations and support services. Our study adds to the current body of evidence indicating that loneliness can predict subsequent TV viewing time and elevated sedentary behavior in women. Therefore, loneliness should be monitored and addressed early on, as this may help to effectively prevent time spent TV viewing.”

    But the researchers are cautious about over-extending their conclusions. “First, due to the limitations of the database, our study utilized self-reported assessment of sedentary behavior and loneliness, which may introduce recall bias,” Zou noted. “Device-based measures, such as accelerometers and inclinometers, can provide more objective data. Second, as our study was observational and epidemiological, our findings demonstrate the correlations rather than causal relationships.”

    “Third, our focus was exclusively on TV viewing without including other types of sedentary behavior. In fact, an increasing number of researchers highlight that different contexts of sedentary behavior have different impacts on mental health. For example, mentally active sedentary behavior, such as reading, may show a different impact than mentally passive sedentary behavior, such as watching TV.”

    “Thus, future studies should employ more complex methods in order to offer a more comprehensive understanding of the relationship between sedentary behavior and mental health. Additionally, more laboratory-based study designs (e.g., randomized controlled trials and sedentary behavior interventions) could be constructed to explore the relationship between sedentary behavior and human well-being, with a particular focus on the context of sedentary behavior (e.g., watching TV versus reading) and the underlying potential neurobiological mechanisms.”

    Despite these limitations, the study has several strengths, including its large sample size and use of a robust statistical model that accounts for stable individual differences. By analyzing the data separately for men and women, the researchers were able to identify important sex-specific patterns that might otherwise have been missed.

    “My long-term goal is to develop a comprehensive understanding of the dynamic relationships between sedentary behavior and human well being across the lifespan, with a particular focus on modifiable lifestyle factors,” Zou explained. “Previous sedentary behavior-mental health studies still lack systematic summarization. The absence of a synthesized framework significantly impedes and limits the development of high-quality studies. Collectively, building upon the current investigation of TV viewing and loneliness, our plan is to propose a sedentary behavior-mental health model that accounts for the context and the type of sedentary behavior.”

    The study, “Bidirectional relationships between television viewing and loneliness in middle-aged and older men and women,” was authored by Zijun Liu, Andre Oliveira Werneck, Fabian Herold, Cassandra J. Lowe, Mats Hallgren, Boris Cheval, Benjamin Tari, Brendon Stubbs, Markus Gerber, Ryan S. Falck, Arthur F. Kramer, Neville Owen, and Liye Zou.

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  • Significance of AAD Guideline Updates for Atopic Dermatitis, with Robert Sidbury, MD, MPH

    Significance of AAD Guideline Updates for Atopic Dermatitis, with Robert Sidbury, MD, MPH

    After a new focused update was issued by the American Academy of Dermatology (AAD), adding to the guidelines for topical and systemic atopic dermatitis treatments in adults, Robert Sidbury, MD, MPH, spoke with HCPLive about the update and its relevance to clinicians and patients.1,2

    Sidbury is known for his role as a professor in the Department of Pediatrics at the University of Washington School of Medicine and as chief of the Division of Dermatology at Seattle Children’s Hospital. Sidbury’s multidisciplinary workgroup recently conducted a systematic review that resulted in this update by the AAD, with the investigators having implemented the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach for assessing evidence on recently approved drugs.2

    “It had a lot to do with just how far down the road the studies [we evaluated] were,” Sidbury explained. “If you look at the National Eczema Association website, it is just a wonderful resource. It’s a patient advocacy group, but it is also a fabulous resource for providers, for journalists, for anyone interested in this space…You can go to a tab on their ‘Research’ page, which lists all of the clinical trials and their various stages of development, phase 1, phase 2, phase 3, and beyond. If you’re in phase 3 development, you’ve passed some significant hurdles, and though it does not mean you’ll be granted FDA approval, it is a significant distance down the road to having a drug you can prescribe.”

    The decision to include this update, specifically regarding 4 newly US Food and Drug Administration (FDA)-approved treatments for atopic dermatitis, was the result of the level of research supporting each of their uses. The therapies were roflumilast cream 0.15%, tapinarof cream 1%, lebrikizumab, and nemolizumab (with topical therapy), with each being recommended by the AAD for physicians to integrate into clinical practice.

    Sidbury noted that this update allows clinicians to have more options for patients who are prone to various side effects. Sidbury used the examples of dupilumab and Janus-Kinase (JAK) inhibitors to describe scenarios in which clinicians may be able to make informed decisions with more alternatives.

    “Dupilumab, for instance, and other IL-13 category blockers, can have conjunctivitis or irritation of the eyes that is non-infectious. It’s an inflammatory conjunctivitis,” Sidbury said. “But if that patient before you, and you’re talking about various options, has a really bad history of conjunctivitis or other ocular disease, not an absolute contraindication to those medications…you’d want to review all of the options with that patient before choosing that one. Similarly, the JAK-inhibitors, another class of medication that is newer, have a boxed warning with various conditions and concerns that may always be important to discuss with patients, but may, given that particular patient’s history and comorbidities, make that class of medications either a good choice or not.”

    To find out more about the AAD’s atopic dermatitis guideline changes, view the full interview video posted above.

    The quotes in this summary were edited for the purposes of clarity.

    Sidbury has reported serving on Pfizer’s advisory board, for which he receives honoraria; acting as an investigator for Brickell Biotech and Galderma USA, with support through grants and research funding; serving as a principal investigator for Regeneron, also receiving grant and research support; and working as a consultant for Galderma Global and Microes, with compensation provided or, in some cases, not received.

    References

    1. Smith T. 4 New Recommendations for Atopic Dermatitis Management, with Robert Sidbury, MD, MPH. HCPLive. July 3, 2025. Accessed July 7, 2025. https://www.hcplive.com/view/4-new-recommendations-atopic-dermatitis-management-robert-sidbury-md-mph.
    2. Davis DMR, Frazer-Green L, Sidbury R, et al. Focused update: Guidelines of care for the management of atopic dermatitis in adults. J Am Acad Dermatol. 2025 Jun 17:S0190-9622(25)02125-5. doi: 10.1016/j.jaad.2025.05.1386. Epub ahead of print. PMID: 40531067.

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  • Dakota Johnson Has Mastered the Perfect Beach Vacation Outfit

    Dakota Johnson Has Mastered the Perfect Beach Vacation Outfit

    Mastering the perfect beach vacation outfit is a conundrum that keeps coming back around—but Dakota Johnson’s jaunt to Ibiza has provided ample inspiration, whether you’re jetting off the the Balearic islands this summer or not.

    Photographed across the Fourth of July holiday, Johnson and friends Kate Hudson, Tom Brady, and Sofia Vergara were seen enjoying their break at Casa Jondal, a hyped, exclusive beach club and restaurant that sits in Ibiza’s southern bay.

    Photo: Backgrid

    Johnson showcased what’s pretty much the perfect beach vacation outfit: A sheer cream, floral lace embroidered dress that hit at the knee, with a brown scoopneck bikini underneath. She accessorized with a purple amethyst pendant necklace layered over a longer gold chain with a gold and onyx heart locket, and a chunky gold ring. Beside her, a pair of simple beige thong flip flops, ready when she is. The look felt like it could have been picked up from one of the local markets, and felt right for sitting beachside, retiring to the club for a long lunch of chargrilled fish and padron peppers, and aimlessly wandering the streets of Ibiza town.

    Her vacation wardrobe, so far, has been all hits, ticking off every It-item we’d want in our carry-on suitcase. She was previously photographed wearing a Dôen floral skirt, the Vogue editor-approved Alaïa ballet flats, a slogan cap, and a very casual rare Gucci green shopper bag from the house’s fall 2025 runway. We know those super hyped Dune flip-flops from The Row are lurking in Johnson’s finca wardrobe for certain, too.

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  • 27 dead in Pakistan after five-storey building collapses in Karachi – Firstpost

    27 dead in Pakistan after five-storey building collapses in Karachi – Firstpost

    Residents reported hearing cracking sounds shortly before the apartment block crumbled around 10:00 am on Friday in Karachi’s impoverished Lyari neighbourhood

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    Rescue teams were in the final stages of clearing the wreckage of a five-storey building that collapsed in Pakistan’s mega city of Karachi killing 27 people, officials said Sunday.

    Residents reported hearing cracking sounds shortly before the apartment block crumbled around 10:00 am on Friday in Karachi’s impoverished Lyari neighbourhood, which was once plagued by gang violence and considered one of the most dangerous areas in Pakistan.

    “Most of the debris has been removed,” Hassaan Khan, a spokesman for government rescue service 1122 told AFP, adding that the death toll stood at 27 on Sunday morning.

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    He expected the operation to finish by the afternoon.

    Authorities said the building had been declared unsafe and eviction notices were sent to occupants between 2022 and 2024, but landlords and some residents told AFP they had not received them.

    “My daughter is under the rubble,” 54-year-old Dev Raj told AFP at the scene on Saturday.

    “She was my beloved daughter. She was so sensitive but is under the burden of debris. She got married just six months ago.”

    Roof and building collapses are common across Pakistan, mainly because of poor safety standards and shoddy construction materials in the South Asian country of more than 240 million people.

    But Karachi, home to more than 20 million, is especially notorious for poor construction, illegal extensions, ageing infrastructure, overcrowding, and lax enforcement of building regulations.

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  • Here Are the Latest Emoji on Your Phone and What Each Emoji Means

    Here Are the Latest Emoji on Your Phone and What Each Emoji Means

    Apple and Samsung brought eight new emoji to their devices this year with the releases of iOS 18.4 and One UI 7. The new emoji include a face with bags under its eyes and a splatter, but what do these new emoji, and the thousands of others, mean? 

    A “😃” or “❤️” are easy to understand, but how are “😩” and “😭” different, and what does it mean when someone sends you food emoji like “🍆” or “🍑”? Over time, emoji meanings have become subjective, depending on a message’s context and wider cultural trends. 

    A tired looking emoji.

    That face says it all.

    Apple

    Which shaking smiley face should you use? Is there a difference between each different colored heart? Does the peach emoji actually mean fruit anymore? Here’s how to figure out what all 3,790 emoji mean and what emoji could be next. 

    Read more: We Could Get a Sasquatch Emoji Soon

    Emojipedia is here to help

    Emojipedia is an online encyclopedia of emoji managed by people who research emoji. The site sorts emoji into nine categories, including Smileys, People, Objects, Activity and more. Each category then breaks down emoji into further subsections. So if you click into Smileys, for example, you’ll see sections like Smiling & Affectionate and Sleepy & Unwell.

    If you click an individual emoji, Emojipedia will give you a brief description of that emoji. For example, here’s what Emojipedia writes about the  “✨” sparkles emoji: 

    “Commonly used to indicate various positive sentiments, including love, happiness, beauty, gratitude, and excitement, as well as newness or cleanliness. 

    May also be used as a form of ✨emphasis✨ or to convey sarcastic or mocking tones.”

    Emojipedia will also give you a list of other emoji that this particular emoji works well with. In the case of the “🎁” wrapped gift emoji, for example, Emojipedia’s suggestions include the “🥳” partying face and the “🛒” shopping cart. 

    Emoji keyboard on iPhone

    What’s a text message without an emoji or two?

    Jason Cipriani/CNET

    Each Emojipedia entry also shows you the different artwork for each emoji across platforms, as well as how the artwork evolved. The emoji entry will also show you shortcodes and other names for each emoji, if applicable.

    What are the most popular emoji?

    You may have your own go-to emoji, but according to Emojipedia, these are the most popular emoji as of the beginning of July. The list changes periodically, so what’s popular now might not be popular next month or around a holiday. Note that not all platforms support all the latest emoji, so they may not all appear on your device.

    What are the latest emoji?

    All the new emoji, including a tired looking face, a radish and a harp

    Emojipedia

    In September, Google unveiled Emoji 16.0, which includes eight new emoji. Here are the new emoji.

    Apple included these emoji with iOS 18.4 in March, and Samsung brought these emoji to some devices with One UI 7 in April and more devices since then. WhatsApp introduced these emoji to its app in January. 

    How often are new emoji added?

    Anyone can submit an idea for a new emoji. The Unicode Standard — a universal character encoding standard — is responsible for creating new emoji. Unicode proposed nine new emoji in November, 2024, including a Sasquatch and an orca. However, those are just proposed emoji. Unicode will decide in September which emoji to add next. 

    Nine proposed new emoji which includes a zoomed in smiley, a fight cloud and a ballet dancer

    Emojipedia

    What about custom emoji, like Apple’s Genmoji?

    Apple unveiled its emoji generator, Genmoji, at WWDC 2024, and the tech giant included the feature in iOS 18.2. However, only people with an iPhone 15 Pro or Pro Max or a device from the iPhone 16 lineup can access Genmoji for now.

    If you can’t use Genmoji and want to create your own custom emoji, Emojipedia is home to two custom emoji generators. 

    An emoji of a pizza in the shape of a heart

    Emojipedia

    First is Emojipedia’s AI emoji generator. You can use this tool to create anything from a frog wearing a cowboy hat to a heart shaped pizza. You type your description of the emoji into the generator, and the tool will create an emoji based on your description. You can then download or copy your custom emoji to your clipboard and use it as a sticker across messaging apps like WhatsApp and iMessage. This emoji generator is free, but you can only generate three emoji per day so make sure you describe your emoji as much as possible so you don’t waste one of your tries. 

    If you do run out of AI emoji generations for the day, you can also use the Emoji Mashup Bot, which combines two emoji from the Twemoji set. You can use this as many times as you want, but you can only choose up to 113 emoji to combine and they are all smileys. That means you can’t be as creative in your creation as you might be in the AI emoji generator. 

    All this just for emoji?

    Yeah, but wait there’s more! Emojipedia also hosts the World Emoji Awards on World Emoji Day, July 17. Awards are given for things like Most Popular New Emoji and Most Anticipated Emoji. Winners are determined by popular vote on X, formerly known as Twitter, and any emoji approved the year prior is eligible to win. 

    New emoji to come to iPhones with the first iOS 16.4 developer beta

    New emoji are added every year, and there are even awards given out for new emoji.

    Emojipedia

    The winner for the Most Popular New Emoji in 2024 was the head shaking horizontally (🙂‍↔️) followed by the head shaking vertically (🙂‍↕️) and the phoenix (🐦‍🔥). The winner of the Most Anticipated Emoji went to the face with bags under its eyes and the Most 2024 Emoji award went to the melting face (🫠) for the second year in a row — it still fits.

    The sparkles (✨) emoji was also given the Lifetime Achievement Award in 2024. Emojipedia wrote that this emoji has been among the most popular emoji since 2015, and it’s been adopted as the go-to image for AI.

    In 2023, the most popular emoji was the pink heart emoji (🩷) and the runner-up was the shaking face (🫨). The most anticipated emoji award in 2023 went to the head shaking horizontally (🙂‍↔️).

    For more, here are the latest approved emoji, how to react to messages with emoji on your iPhone and how to use emoji instead of comments in Google Docs.


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  • Today’s Wordle Hints for July 7, 2025 – The New York Times

    1. Today’s Wordle Hints for July 7, 2025  The New York Times
    2. Wordle today: The answer and hints for July 6, 2025  Mashable
    3. Today’s Wordle Hints for July 6, 2025  The New York Times
    4. Today’s Wordle Answer will touch your heart: Hints, tips, and strategies to solve the Sunday puzzle #1478  The Economic Times
    5. Today’s Wordle Hints and Answer for Puzzle #1477, July 5  TODAY.com

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  • United players in Saturday’s Euro 2025 action | 5 July 2025

    United players in Saturday’s Euro 2025 action | 5 July 2025

    The evening slot saw France achieve a 2-1 victory over Sarina Wiegman’s Lionesses, despite the latter putting up a hearty fight towards the end.

    Reds striker Melvine Malard was among those celebrating Les Bleues’ triumph at the final whistle, having replaced Chelsea star Sandy Baltimore – scorer of her side’s second goal – just after the hour mark.

    Blues midfielder Kiera Walsh pulled one back for England in the final few minutes, having been joined by substitutes Ella Toone and Grace Clinton earlier in the second half, and Wiegman’s charges left France scrambling in stoppage time, but their opponents did just enough to prevent a late equaliser.

    United captain Maya Le Tissier was also on the bench for the Lionesses, but wasn’t called upon on this occasion.

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  • 4 key trends dominating office design and planning: ABM CEO Scott Salmirs

    4 key trends dominating office design and planning: ABM CEO Scott Salmirs

    Scott Salmirs has a unique view of the RTO tug of war between workers and bosses that has taken over American offices over the past few years. For 22 years, Salmirs has served as the CEO of ABM Industries, a company that maintains work spaces for more than half the companies on the Fortune 500. 

    While it seems like the RTO battles have reached a plateau, with companies settling into a hybrid detente, Salmirs says the fight isn’t over; many CEOs are secretly hoping to add on another day to two of in-person work to employee schedules. That’s particularly true now that the labor market has shifted power away from workers, and back into the hands of bosses. 

    “This return to office, it’s still happening, absolutely. I think with this economic climate, we’ll really see what companies are thinking,” Salmirs tells Fortune

    But there are a few key changes that businesses are making to their offices as they try to lure workers back, says Salmirs. Many large companies are cutting headcount and streamline operations; as a result, they’re trading in more outdated buildings for smaller, higher-quality spaces in centralized locations as a way to attract workers. They’re also ditching their open-plan offices and adding more private spaces to make the space “more hospitable,” he says. And of course, bosses are making sure that the pantries are fully stocked with snacks.  

    “They’re looking closely at pantries and what they’re serving, including the coffee, the snacks, all that good stuff,” he says. “It really matters to employees.”

    Fortune sat down with Salmirs to discuss the future of office space and what workers can expect going forward.

    Fortune: What kinds of trends are you seeing when it comes to RTO? 

    Salmirs: There’s been this commercial real estate crisis, if you will, about people not coming to work, and what’s going to happen with office buildings. Predominantly Class A buildings have been really resilient. As people are coming back, the benchmark now is a solid three to four days per week. Over the last 18 months, it’s been more and more. 

    But the little-known fact about this more difficult time that we’re having right now economically, is that it gives management teams the ability, especially with the hiring market not being great, to ask workers to come back into the office more. Four years ago there was no way that a management team could tell people they’re coming back. they’ll just go get another job. Not so much now.

    What does the future of RTO look like? 

    I think with this economic climate, we’ll really see what companies are thinking. It’ll be an incremental “one more day.” So if you’re at three, it’s going to be four, if you’re at four it could be five. This will be, in my mind, over the next six to nine months.

    We were promised an office apocalypse a few years ago, when people were saying that corporate real estate would be empty. What are you seeing in the market right now?

    We classify real estate into three buckets, class A, class B and class C. Class A is the good buildings, the ones with really good amenities, and those are doing great. I mean the leasing rates are off the hook, the occupancy rate is like 95%. It’s the B and C class spaces that are struggling a lot more. 

    Say you have 20,000 square feet, and are in a class B building, paying $50 a square foot for rent. Now with not as many people coming in, you can pay $100 a foot for a 10,000 square foot building with top amenities in the best location because they know that if you want to get your people back to the office, you’ve got to give them good space. 

    What are you seeing as the top priorities for companies right now when it comes to office space? 

    I think it’s how they organize the space, because now that more people are coming back, there’s usually a shortage of private spaces. People used to want this big open plan where everyone was sitting at long desks. To get people back, companies are realizing that they have to give people some more privacy. So we’re seeing them convert open space into conference rooms, or areas with more secluded space.

    Also, they’re looking closely at pantries and what they’re serving, including the coffee, the snacks, all that good stuff. It really matters to employees.

    Since COVID, companies are also prioritizing clean spaces. We’re seeing a lot of [companies] making sure that they could say to employees that their workspace is healthy and clean. Some clients are moving some of our cleaning people on to the day staff, so they’re more visible, so people can see them cleaning and walking around the office.  

    The most important thing is to really pay attention to people’s work habits. Are they working in groups collaboratively? Is it solo work? Are they on the phone a lot? Are they on video a lot? What we always say to our clients is that you really have to start with understanding the culture of the organization and the different use cases.

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